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Severe asthma in pediatrics: Outcomes of the implementation of a special health care protocol
Verónica Giubergia1, María J Ramirez Farías2, Verónica Pérez2
1Servicio de Neumonología, Hospital "Prof. Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires. verogiubergia@gmail.com.
Insights
Severe asthma patients were classified into treatment-resistant (STRA) or difficult-to-control (SDCA) groups. While SDCA patients showed lower adherence, both groups achieved significant asthma control after 6 months.
Area of Science:
- Pulmonology
- Clinical Medicine
- Asthma Research
Background:
- Severe asthma affects 5-7% of all asthma cases.
- The WHO classifies severe asthma into severe, treatment-resistant asthma (STRA) or severe, difficult-to-control asthma (SDCA).
Purpose of the Study:
- To analyze clinical, functional, and therapeutic characteristics of patients with STRA or SDCA.
- To compare patient profiles and treatment outcomes between STRA and SDCA groups.
Main Methods:
- Cross-sectional, observational, and analytical study design.
- Assessment of diagnosis, clinical and functional control, comorbidities, treatment adherence, inhalation technique, and environmental factors.
- Inclusion of 69 patients: 33 with STRA and 36 with SDCA.
Main Results:
- STRA patients had higher rates of prior hospitalization (100% vs 87.8%) and ICU admission (63% vs 54%) compared to SDCA patients.
- SDCA patients exhibited lower treatment adherence (p=0.01) and required lower inhaled corticosteroid doses.
- STRA patients showed mild obstructive ventilatory defects, while SDCA patients had normal baseline spirometry.
Conclusions:
- Lower treatment adherence in the SDCA group correlated with reduced treatment doses.
- Despite challenges, over 75% of children in both STRA and SDCA groups achieved asthma control after 6 months.
- Omalizumab was indicated for STRA patients, highlighting targeted therapy needs.
Introduction:
Severe asthma accounts for 5-7% of all asthma cases. The World Health Organization proposed a follow-up protocol to classify cases into severe, treatment-resistant asthma (STRA) or severe, difficult-to-control asthma (SDCA).
Objective:
To analyze the clinical, functional, and therapeutic characteristics of patients with STRA or SDCA.
Methods:
Cross-sectional, observational, and analytical study to assess the diagnosis, the extent of control (clinical and functional), comorbidities, treatment adherence, inhalation technique, and environmental factors in patients with severe asthma.
Results:
A total of 69 patients were included: STRA (n= 33) and SDCA (n= 36). In the group with STRA, 100% of patients had been previously hospitalized due to asthma compared to 87.8% in the group with SDCA (p= 0.03). In the group with STRA, 63% required admission to the intensive care unit (ICU); 82%, ventilatory support; and 1 patient, tracheostomy. In the group with SDCA, 54% required admission to the ICU; and 33%, ventilatory support (p= 0.03).The baseline spirometry was normal in the SDCA group; a mild obstructive ventilatory defect was observed in the STRA group (p= 0.009).In the SDCA group, treatment adherence was lower (p= 0.01). Higher inhaled corticosteroid doses were required in the STRA group (p= 0.0001). Omalizumab was indicated in the case of STRA (p= 0.0001). After 6 months of follow-up, more than 75% of children in both groups achieved asthma control.
Conclusions:
A significant lack of treatment adherence was observed in the SDCA group. In this group, treatment doses were reduced. Asthma was controlled in a high percentage of children with STRA and SDCA.
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