Epigenetic changes in childhood asthma: a path to precision medicine

The 2023 Global Initiative for Asthma (GINA) report highlights a significant rise in asthma rates particularly in low- and middle-income countries, with urbanization and exposure to environmental pollutants being key contributing factors. Children exposed to environmental influences throughout their critical developmental periods may experience epigenetic changes that could predispose them to asthma in the future. However, there are still issues implementing these findings in clinical settings, necessitating more research and technological advancements. The knowledge of epigenetics in childhood asthma might bridge the gap in knowledge of disease etiology and help the creation of precision medicine approaches. By integrating epigenetic indicators into diagnostic and therapy methods, clinicians can move closer to customized care, benefiting children with asthma. This review emphasizes the significance of epigenetic mechanisms in the development of pediatric asthma and the important associated genes like ORAI1, IL4, ADAM33, GSTM1, FLG, GATA3, STAT6, TNF, CD14, IKZF3, MUC5AC, and ORMDL3. We will also review the role of important epigenetic changes including non-coding RNAs, DNA methylation, and histone modifications in the pathophysiology of asthma. Furthermore, the potential of epigenetics as biomarkers for the diagnosis and prognosis of asthma and the therapeutic uses of epigenetic-based therapies such as DNA methyltransferase inhibitors and histone deacetylase (HDAC) inhibitors have been explored.