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Published on: November 4, 2010
Difficult to control asthma in children
Louise Fleming1, Nicola Wilson, Andrew Bush
1Department of Paediatric Respiratory Medicine, Imperial College of Science, Technology and Medicine at the National Heart and Lung Institute, London, UK.
Insights
Managing difficult childhood asthma involves accurate diagnosis and targeted treatment. Noninvasive inflammation markers aid in monitoring control and treatment effects, balancing efficacy with corticosteroid side effects.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Inflammation Biomarkers
Background:
- Difficult childhood asthma requires careful management due to high corticosteroid doses and potential side effects.
- Ensuring accurate diagnosis and identifying reasons for poor control are crucial for effective treatment.
Purpose of the Study:
- To review the systematic approach for managing children with difficult asthma.
- To highlight the importance of balancing therapeutic efficacy with corticosteroid side effects.
- To emphasize targeted treatment based on characterized reasons for poor control.
Main Methods:
- Review of recent data correlating invasive and noninvasive airway eosinophil measurements.
- Evaluation of noninvasive markers for determining asthma phenotype.
- Assessment of evidence for repeated measures in monitoring asthma control and treatment effects.
Main Results:
- Noninvasive inflammation markers correlate with invasive measurements and can identify asthma phenotypes.
- Repeated noninvasive measures show utility in monitoring control and treatment responses.
- High-dose corticosteroid side effects and poor treatment adherence remain significant challenges.
Conclusions:
- Children with difficult asthma are a diverse group.
- Noninvasive inflammation markers can improve characterization and monitoring.
- Further prospective trials are needed for new, phenotype-specific treatments.
Purpose Of Review:
The management of children with difficult asthma requires a systematic approach. These children are prescribed high doses of inhaled or oral corticosteroids and a balance must be struck between therapeutic efficacy and side effects. It is important to ensure the diagnosis is correct and that the reasons for poor control in a given child are characterized so that treatment can be targeted for maximal effect.
Recent Findings:
Recent data have demonstrated the correlation between invasive and noninvasive measurement of airway eosinophils. Noninvasive markers of inflammation can be used to determine phenotype and there is increasing evidence on the utility of repeated measures to monitor control and treatment effects. Side effects of high-dose corticosteroids remain a concern. The emergence of new therapies may be of benefit. These are often expensive, however, and have the potential for major side effects. Adherence remains a significant obstacle to the effective management of difficult asthma.
Summary:
Children with difficult asthma are a heterogeneous group. Characterization and monitoring of these children can be enhanced by measurements of noninvasive markers of inflammation. Further evaluation of new and phenotype-specific treatments for children with difficult asthma need to be evaluated in prospective randomized controlled trials.
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