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Difficult vs. Severe Asthma: Definition and Limits of Asthma Control in the Pediatric Population
Amelia Licari1, Ilaria Brambilla1, Alessia Marseglia1
1Department of Pediatric, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Insights
Assessing asthma control in children involves evaluating symptom control and future risks. Identifying factors contributing to uncontrolled asthma is crucial for effective management, especially in severe cases.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Clinical Therapeutics
Background:
- Asthma control is key in pediatric care, defined by symptom reduction and minimized future risks.
- Current guidelines recognize symptom control and future risk (attacks, lung function decline, side effects) as key domains.
- While many children achieve control with standard therapies, a subset faces significant morbidity due to uncontrolled asthma.
Purpose of the Study:
- To review the current understanding of asthma control in children.
- To describe monitoring tools for assessing asthma control in clinical practice and research.
- To evaluate factors, including comorbidities and modifiable/non-modifiable elements, linked to uncontrolled childhood asthma, particularly severe cases.
Main Methods:
- Literature review focusing on asthma control definitions, assessment tools, and contributing factors in children.
- Analysis of current guidelines and research on pediatric asthma control.
- Evaluation of comorbidities and risk factors associated with difficult-to-treat and severe asthma in children.
Main Results:
- Asthma control encompasses symptom control and future risk mitigation.
- Standard therapies effectively control asthma in most children, but a subgroup remains uncontrolled.
- Multidisciplinary assessment is vital for children with difficult-to-treat or severe asthma.
Conclusions:
- Effective asthma management requires a comprehensive approach to control assessment.
- Identifying factors contributing to uncontrolled asthma is essential for tailoring treatment strategies.
- Further research into severe and difficult-to-treat childhood asthma is needed to improve patient outcomes.
Abstract:
Evaluating the degree of disease control is pivotal when assessing a patient with asthma. Asthma control is defined as the degree to which manifestations of the disease are reduced or removed by therapy. Two domains of asthma control are identified in the guidelines: symptom control and future risk of poor asthma outcomes, including asthma attacks, accelerated decline in lung function, or treatment-related side effects. Over the past decade, the definition and the tools of asthma control have been substantially implemented so that the majority of children with asthma have their disease well controlled with standard therapies. However, a small subset of asthmatic children still requires maximal therapy to achieve or maintain symptom control and experience considerable morbidity. Childhood uncontrolled asthma is a heterogeneous group and represents a clinical and therapeutic challenge requiring a multidisciplinary systematic assessment. The identification of the factors that may contribute to the gain or loss of control in asthma is essential in differentiating children with difficult-to-treat asthma from those with severe asthma that is resistant to traditional therapies. The aim of this review is to focus on current concept of asthma control, describing monitoring tools currently used to assess asthma control in clinical practice and research, and evaluating comorbidities and modifiable and non-modifiable factors associated with uncontrolled asthma in children, with particular reference to severe asthma.
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