[Round Table: Severe asthma in pediatrics. Concepts and predisposing factors]

Given the clinical and functional characteristics of severe asthma, we will look at the factors that predispose to potentially fatal asthma. They can be divided into three groups: a) factors related to medical care: error of diagnosis of asthma and severity, deficiencies in the treatment prescribed, lack of control of treatment, frequent changes of doctor, lack of diagnostic tools; b) factors related to the patient and the environment: denial of the disease, failure to comply with or abandonment of treatment, underrating the severity of attacks, age (adolescence), coexistence of psychiatric disorder (depression); c) disease-dependent factors: admissions to hospital, need for mechanical ventilation on occasion, increase of symptoms during the last year, need for substantial medication. Adolescence is a critical stage of life in asthma. It implicitly involves a number of risk factors, all of which are age-dependent: refusal to acknowledge the illness, resistance to treatment (in particular as regards continuity and frequency of doses) lack of self-esteem, lack of confidence in the doctor, the beginning of the smoking habit. Another key factor is the coexistence of depression and asthma. In addition to the low self-esteem due to the affective disorder (which will in itself influence any form of treatment) depression is associated with a higher incidence of illnesses --especially infectious illnesses-- which can also aggravate asthma. Anxiety and stressful circumstances in general are factors that negatively affect the illness. Factors that influence the evolution of the illness are the following: factors that influence asthma severity: patient-dependent, sensitivization-dependent, environment-dependent, treatment-dependent, illness-dependent, dependent on respiratory function exploration.