Related Experiment Video
Updated: Mar 20, 2026
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
How to manage a child with difficult asthma?
Sejal Saglani1,2, Louise Fleming1,2
1a Inflammation, Repair and Development , National Heart & Lung Institute, Imperial College London , London , UK.
Insights
Identifying and addressing modifiable factors like medication adherence, environmental triggers, and psychosocial issues is crucial for managing difficult childhood asthma. Specialist care ensures optimal outcomes and prevents unnecessary treatments for pediatric asthma patients.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Allergy and Immunology
Background:
- Difficult childhood asthma leads to significant morbidity, with poor control despite high-dose treatments.
- Persistent challenges necessitate detailed assessments to identify underlying modifiable factors.
- Non-adherence, environmental exposures, and psychosocial issues are key contributors to uncontrolled asthma in children.
Purpose of the Study:
- To present a practical diagnostic and management approach for difficult childhood asthma.
- To outline long-term assessments for identifying progression to severe asthma.
- To emphasize the role of multi-disciplinary teams in managing pediatric difficult asthma.
Main Methods:
- Review of current literature and clinical guidelines for difficult asthma diagnosis and management.
- Focus on identifying and addressing modifiable factors impacting asthma control.
- Highlighting the necessity of specialist centers and multi-disciplinary teams.
Main Results:
- Effective management requires identifying and addressing non-adherence, environmental triggers, and psychosocial factors.
- A multi-disciplinary approach is critical for optimal assessment and intervention.
- Specialist center management is recommended for complex pediatric difficult asthma cases.
Conclusions:
- Optimizing the management of difficult childhood asthma requires a comprehensive, multi-disciplinary approach.
- Addressing modifiable factors is essential for improving asthma control and reducing morbidity.
- Specialist care, while resource-intensive, offers significant long-term lung health benefits for children.
Introduction:
Children with difficult asthma have significant morbidity and fail to achieve asthma control despite being prescribed high dose maintenance treatment. If control remains poor after diagnostic confirmation, detailed assessments of the reasons for asthma being difficult-to-control are needed. Underlying modifiable factors including non-adherence to medication, persistent environmental exposures that trigger asthma symptoms and psychosocial factors contribute to poor control in these patients.
Areas Covered:
The focus of this review is to provide a practical approach to the diagnosis and management of difficult asthma including an overview of long term assessments to identify potential progression to true, severe asthma. A multi-disciplinary team is critical to enable modifiable factors to be identified and addressed. Significant resources are required to manage paediatric difficult asthma optimally and only specialist centres should be tasked with the assessment of these patients. Although this may have an impact on healthcare resources, long term benefits for lung health are significant. Expert commentary: The management of paediatric difficult asthma is not simple and involves numerous professionals with varied expertise. However, if it is not undertaken with the appropriate skills, there is a significant risk of children receiving inappropriate invasive investigations and therapies that will have no impact on morbidity.
Related Concept Videos
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:30Asthma-IV: Nursing Management
First, in...
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:19Antiasthma Drugs: Leukotriene Modifiers
Leukotriene modifiers work through two distinct mechanisms:
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.