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Difficult asthma
1Department of Pediatrics, Sir Ganga Ram Hospital, New Rajinder Nagar, New Delhi. chughk@bol.net.in
Indian Journal of Pediatrics
|May 1, 2002
Summary
Difficult asthma in children requires a thorough investigation for alternative diagnoses and treatment failures. Optimizing inhaled steroids and considering steroid-sparing agents are key, with specialist care for severe or resistant cases.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Asthma uncontrolled despite guideline-based therapy is termed difficult-to-manage asthma.
- Several phenotypes exist, but alternative diagnoses must be ruled out first.
Purpose of the Study:
- To outline the diagnostic approach and management strategies for difficult-to-manage asthma in children.
- To emphasize the importance of identifying underlying causes and optimizing treatment.
Main Methods:
- Review of diagnostic considerations including alternative diagnoses (e.g., cystic fibrosis, foreign body aspiration).
- Analysis of treatment failure causes (e.g., noncompliance, incorrect inhaler technique, steroid resistance).
- Discussion of pharmacological management including inhaled corticosteroids, steroid-sparing agents, and advanced therapies.
Main Results:
- A systematic approach is crucial to identify underlying conditions mimicking difficult asthma.
- Optimizing inhaled steroid therapy and adding steroid-sparing agents (e.g., long-acting beta-2 agonists, leukotriene inhibitors) control most cases.
- A small subset requires continuous oral steroids or specialized management at centers with access to experimental drugs.
Conclusions:
- Thorough evaluation for alternative diagnoses and contributing factors is essential for children with difficult asthma.
- Most cases can be managed with optimized inhaled steroids and steroid-sparing agents.
- Specialized centers are necessary for managing steroid-resistant or severe cases requiring advanced therapies.