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Difficult asthma.

K Chugh1

  • 1Department of Pediatrics, Sir Ganga Ram Hospital, New Rajinder Nagar, New Delhi. chughk@bol.net.in

Indian Journal of Pediatrics
|May 1, 2002
PubMed
Summary
This summary is machine-generated.

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.

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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.

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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.