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Getting the basics right resolves most cases of uncontrolled and problematic asthma
Eric P de Groot1, Wendy J Kreggemeijer1, Paul L P Brand1,2
1Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands.
Insights
Most children with uncontrolled asthma have an identifiable cause, such as poor adherence or environmental triggers. True therapy-resistant asthma is rare in pediatric patients, with most cases resolved by addressing basic asthma management issues.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Uncontrolled asthma in children poses a significant clinical challenge.
- The prevalence and causes of true therapy-resistant asthma in pediatric populations are not well-defined.
Purpose of the Study:
- To investigate the underlying causes of uncontrolled asthma in children.
- To determine the prevalence of true therapy-resistant asthma in this cohort.
Main Methods:
- Retrospective chart review of 142 children (aged 5-17) with uncontrolled asthma.
- Patients were referred to a hospital-based pediatric asthma clinic over a five-year period.
Main Results:
- An underlying cause was identified in 97.2% of children.
- Common causes included poor adherence (37.3%), environmental triggers (28.2%), comorbidities (19.7%), incorrect inhaler technique (7.7%), and incorrect diagnosis (4.2%).
- True therapy-resistant asthma was found in only 2.8% of cases; asthma control and lung function normalized after addressing identified issues.
Conclusions:
- Remedial causes in basic asthma management are prevalent in children with uncontrolled asthma.
- True therapy-resistant asthma is rare in children, emphasizing the importance of addressing adherence, triggers, comorbidities, and technique.
Aim:
The prevalence of true therapy-resistant asthma among children whose asthma remains uncontrolled, despite daily controller therapy, is unknown. The aim of this study was to investigate the underlying causes in children with uncontrolled asthma.
Methods:
This was a retrospective chart review of 142 children aged from five to 17 years over a five-year period. The patients had uncontrolled asthma and were referred by general practitioners to a hospital-based paediatric asthma clinic.
Results:
An underlying cause for uncontrolled asthma was found in 138 children (97.2%). The causes were poor adherence (n = 53, 37.3%), ongoing exposure to environmental triggers (n = 40, 28.2%), comorbidities (n = 28, 19.7%), incorrect inhaler technique (n = 11, 7.7%) and incorrect diagnosis (n = 6, 4.2%). After properly addressing these basics in asthma management, the asthma was well controlled in all 138 patients and lung function was normal. Only four children (2.8%) fulfilled the criteria for true therapy-resistant asthma.
Conclusion:
A remedial cause in the basics of asthma management could be found in 97% of children with uncontrolled asthma referred to a hospital-based asthma clinic. True therapy-resistant asthma was found to be very rare in children.
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