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[Difficult asthma in children].

C Iliescu1, I Tillie-Leblond, A Deschildre

  • 1Service de pneumologie et d'immunoallergologie, CHRU, Lille, France.

Archives De Pediatrie : Organe Officiel De La Societe Francaise De Pediatrie
|January 22, 2003
PubMed
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Difficult asthma in children involves persistent symptoms or airway obstruction despite standard treatments. Understanding its underlying pathology is crucial for effective, specialized management strategies.

Area of Science:

  • Pediatric Pulmonology
  • Asthma Pathophysiology
  • Airway Inflammation

Context:

  • Difficult asthma in children is characterized by persistent exacerbations or symptoms requiring frequent rescue bronchodilators, or ongoing airway obstruction.
  • This condition persists despite high-dose inhaled corticosteroids (>/= 800 microg/d beclomethasone equivalent) and long-acting beta-2 agonists.
  • Initial management involves differentiating true difficult asthma from conditions mimicking asthma, poor treatment compliance, or avoidable exacerbating factors.

Purpose:

  • To define difficult asthma in children and outline current management approaches.
  • To highlight the unknown pathological bases of genuine difficult asthma.
  • To emphasize the need for specialized care, including airway inflammation evaluation.

Summary:

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  • Difficult asthma is defined by persistent symptoms or obstruction despite optimal medical therapy.
  • Management requires ruling out mimics, poor compliance, and environmental triggers.
  • Genuine difficult asthma's pathophysiology, involving cellular patterns (eosinophilic, neutrophilic) and airway remodeling, remains unclear.
  • Specialized care, including airway inflammation assessment via bronchoalveolar lavage and biopsies, is essential.

Impact:

  • Improved understanding of difficult asthma's underlying mechanisms.
  • Development of targeted therapies for pediatric difficult asthma.
  • Enhanced diagnostic and management strategies for clinicians treating severe pediatric asthma cases.