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Related Experiment Videos

Management of unresponsive asthma.

S K Kabra1, R Lodha

  • 1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. skkabra@hotmail.com

Indian Journal of Pediatrics
|September 4, 2004
PubMed
Summary
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Difficult asthma requires careful diagnosis and treatment. Identifying steroid-resistant asthma involves specific tests, guiding alternative therapies like cyclosporin for eosinophilic inflammation or antibiotics for neutrophilic types.

Area of Science:

  • Pulmonology
  • Allergy and Immunology
  • Pharmacology

Background:

  • Difficult asthma is uncontrolled asthma despite high-dose inhaled corticosteroids (>800 µg budesonide/day).
  • Poor asthma control includes frequent bronchodilator use, school absence, or monthly wheezing.
  • Common causes of poor response include misdiagnosis, incorrect medication, poor adherence, and comorbidities.

Purpose of the Study:

  • To define difficult asthma and its management strategies.
  • To outline diagnostic approaches for steroid-resistant asthma.
  • To suggest alternative treatments for specific inflammatory profiles in difficult asthma.

Main Methods:

  • Review of difficult asthma definitions and causes.
  • Description of diagnostic criteria for steroid resistance, including prednisolone challenge and biomarker assessment.

Related Experiment Videos

  • Discussion of treatment options based on biopsy findings.

    • Main Results:

    • Steroid-resistant asthma affects an estimated 1 in 1000-10000 patients.
    • Fiberoptic bronchoscopy with biopsy is indicated for non-responsive cases.
    • Eosinophilic inflammation may respond to cyclosporin; neutrophilic inflammation may benefit from macrolides, 5-lipoxygenase inhibitors, or theophyllines.

    Conclusions:

    • Accurate diagnosis and adherence are crucial for difficult asthma management.
    • Steroid resistance necessitates further investigation via bronchoscopy and biopsy.
    • Targeted anti-inflammatory therapies can be effective for specific asthma phenotypes.