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Children with difficult asthma: a practical approach
1Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK.
Insights
Children with difficult asthma benefit from intensive clinical trial management, regardless of medication. Optimizing asthma control requires careful diagnosis, adherence support, and identifying triggers for better treatment strategies.
Area of Science:
- Pediatric Pulmonology
- Clinical Trial Design
- Asthma Pathophysiology
Background:
- Many open studies show benefits from innovative asthma treatments.
- Placebo groups in trials also show improvements, suggesting high patient support is key.
Purpose of the Study:
- To investigate the benefits of intensive management in children with difficult asthma.
- To highlight the need for understanding severe asthma subtypes for targeted therapies.
Main Methods:
- Review of open and placebo-controlled trials for steroid-dependent asthma.
- Analysis of factors contributing to asthma control in clinical trial settings.
Main Results:
- Children with difficult asthma improve with intensive input, irrespective of specific medication.
- Intensive management, focusing on diagnosis and adherence, is crucial for asthma control.
Conclusions:
- High-input clinical trial management benefits children with difficult asthma.
- Further research into severe asthma subtypes is needed for personalized, steroid-sparing treatments.
Abstract:
Many open studies investigating the effects of innovative treatments for steroid-dependent asthma demonstrate some benefit. This is also true of the majority of placebo arms in placebo-controlled trials. This suggests that children with difficult asthma benefit from the high level of input that is typically provided in clinical trials, with or without additional medication. Such intensive management of patients, with the emphasis on establishing the diagnosis, improving adherence, and identifying provoking factors, is the key to optimizing asthma control for these children. For patients with genuinely severe asthma, despite high doses of conventional treatment, a greater understanding of the pathological basis of persistent symptoms is needed. Identification of different pathological subtypes of severe asthma should allow for more rational prescribing of asthma therapy, as well as the design of further trials of potential steroid-sparing treatments.