This festive period, Three Wise Women from the Faculty of Medicine give us the gift of wisdom.
Professor Sejal Saglani, Professor of Paediatric Respiratory Medicine in the National Heart and Lung Institute and Director of Imperial’s Centre for Paediatrics and Child Health (PaeCH), shines a light on the pressing need to transform how we understand and manage childhood asthma. She discusses why the youngest children face the greatest challenges, how early-life illness shapes long-term health, and the critical role of research and advocacy in addressing inequalities that begin from birth. Her blog is a call to action: if we are to secure lifelong health, we must begin with the earliest years.
Asthma is the most common long-term condition affecting children of all ages worldwide. In the UK, around 10% of children live with asthma – meaning at least two or three children in every classroom. Among these, those under the age of five face the greatest challenges: they experience the most acute attacks, have the highest number of hospital admissions, and account for 75% of all emergency department visits for childhood asthma. Despite this significant burden, the rate of attacks and hospitalisations have remained unchanged for over 20 years.
This time of year brings the issue into sharp focus. Most admissions occur during the autumn and winter months. Parents and families live in a constant state of vigilance, never knowing whether the next runny nose will simply be a cold or will escalate into yet another visit to hospital with wheezing and breathlessness.
Why research in under-5s matters
Finding better treatments to prevent repeated asthma attacks in young children is what drives my work. Toddlers, unlike older children and adults, cannot reliably perform lung function tests, and deciphering the mechanisms behind their illness is far from easy. As a result, many researchers avoid this age group altogether. But if we all turn away, nothing will change – and the long-term harms these children will face will persist.
We know that frequent or severe asthma attacks in early childhood lead to a measurable loss of lung function within the first five to six years of life. This early deficit never fully recovers, putting individuals at significantly higher risk of developing chronic obstructive pulmonary disease (COPD) and increasing their likelihood of cardiac and metabolic diseases, such as diabetes in adulthood. In some cases, it can even contribute to premature mortality. Difficultly is not an excuse for inaction. Our efforts will bear fruit – and supporting early career researchers to recognise the scale and urgency of the problem is crucial if we are to make progress.
The wider impact of early adversity
The long-term consequences of poor health in early childhood extend far beyond lung diseases. Adverse childhood events – trauma, stress and adversity during childhood or adolescence – have profound and lasting effects on an adult’s life. They increase the risk of cardiovascular disease, cancer and mental health disorders. Socioeconomic deprivation adds an additional layer of stress, and the heaviest burden consistently falls on children from the lowest-income backgrounds.
Advocating for children through PaeCH
My second passion lies in advocating for children’s lifelong health through the Centre for Paediatrics and Child Health (PaeCH) at Imperial. Without a formal Department of Paediatrics, there is a risk that child health research could lose visibility or recognition. Yet this absence has pushed us to be bold, innovative, and determined in ensuring children’s health remains a priority.
Having formed a Faculty Centre five years ago, we’ve brought together excellent paediatric researchers and created a like-minded community, committed to ensuring the health needs of children remain a priority. Critical and seamless integration with our NHS partners, and a focus on nurturing our early career researchers, has helped to cultivate an inclusive, positive, and highly visible research culture. The inclusion of this “wise woman’s” reflections in this blog is, perhaps, a testament to our persistence – and our commitment to ensuring the children’s voice remains loud and clear.
If we are to improve lifelong health, we must get things right from the very beginning.