Severe Asthma: Challenges and Pitfalls in Management
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A small but significant subset of asthmatic children show a lack of response to standard management, resulting in further intensification of therapy to optimise symptom control and may remain symptomatic despite maximal therapy. Severe asthma results in increased risk of adverse outcomes whilst contributing significantly to the economic burden on the nation’s health resources. The ERS / ATS guidelines were published in 2014 and form the basis of identifying, evaluating and managing severe asthmatic children. However, much of this evidence is extrapolated from adult studies and may be inappropriate in children as unlike adults, children have a more atopic phenotype. Severe asthma is an umbrella term and may represent several overlapping heterogeneous wheezing entities. This chapter aims at discussing the strategies employed in managing severe asthmatic children with particular focus on diagnostic challenges and management pitfalls. Particular emphasis is put into the logical and systematic approach to a child with severe asthma and describes the multidisciplinary approach to manage these children. Finally, this chapter describes the novel therapies available in children and in adults in managing this challenging condition.
KeywordsSevere asthma Severe therapy resistant asthma Asthma plus Difficult asthma Biologic therapy
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- 13.Bush A, Nagakumar P. Preschool wheezing phenotypes. Eur Med J [Internet]. 2016 Jan 26. Available at: http://emjreviews.com/therapeutic-area/respiratory/preschool-wheezing-phenotypes/. Accessed on 15 Feb 2018.
- 19.Kantar A, Chang AB, Shields MD, et al. ERS statement on protracted bacterial bronchitis in children. Eur Respir J. 2017;50. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593377/. Accessed on 15 Feb 2018.
- 22.Horváth I, Barnes PJ, Loukides S, et al. A European Respiratory Society technical standard: exhaled biomarkers in lung disease. Eur Respir J. 2017;49(4). https://doi.org/10.1183/13993003.00965-2016.
- 23.Coates AL, Wanger J, Cockcroft DW, et al; The Bronchoprovocation Testing Task Force. ERS technical standard on bronchial challenge testing: general considerations and performance of methacholine challenge tests. Eur Respir J. 2017;49(5). https://doi.org/10.1183/13993003.01526-2016.
- 24.Cotes JE, Reed JW. Recommendations on the use of exercise testing in clinical practice. Eur Respir J. 2007;29:1064–6. https://doi.org/10.1183/09031936.00006607.
- 27.Maitra A. Assessment of airway inflammation. In: Lodha R, Kabra SK, editors. Essential Pediatric Pulmonology, 3rd ed. New Delhi: Jaypee Brothers; 2018. p. 428.Google Scholar
- 33.Weinmayr G, Forastiere F, Büchele G, Jaensch A, Strachan DP, Nagel G. Overweight/obesity and respiratory and allergic disease in children: international study of asthma and allergies in childhood (ISAAC) phase two. PLoS ONE. 2014;9. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4256390/. Accessed on 16 Feb 2018.
- 46.Chan AHY, Stewart AW, Foster JM, Mitchell EA, Camargo CA, Harrison J. Factors associated with medication adherence in school-aged children with asthma. ERJ Open Res 2016; 2(1). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005164/. Accessed on 17 Feb 2018.
- 59.Yorke J, Shuldham C. Family therapy for chronic asthma in children. Cochrane Database Syst Rev. 2005;2:CD000089.Google Scholar
- 60.Fitzpatrick AM, Teague WG, Meyers DA, et al. Heterogeneity of severe asthma in childhood: confirmation by cluster analysis of children in the National Institute of Health/National Heart, Lung and Blood Institute Severe Asthma Research Program. J Allergy Clin Immunol. 2011;127:382–9.e1-13.CrossRefPubMedGoogle Scholar
- 61.Howrylak JA, Fuhlbrigge AL, Strunk RC, Zeiger RS, Weiss ST, Raby BA. Classification of childhood asthma phenotypes and long-term clinical responses to inhaled anti-inflammatory medications. J Allergy Clin Immunol. 2014;133:1289–300, 1300.e1-12.Google Scholar
- 75.Torrego A, Solà I, Munoz AM, et al. Bronchial thermoplasty for moderate or severe persistent asthma in adults. Cochrane Database Syst Rev. 2014;3:CD009910.Google Scholar