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Severe asthma in children: Evaluation and management
Mehtap Haktanir Abul1, Wanda Phipatanakul2
1Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Insights
Severe asthma in children poses significant health risks. Differentiating severe, difficult-to-treat asthma from other issues is key for effective management and improved quality of life.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Severe asthma in children is linked to substantial morbidity, including adverse outcomes like medication side effects and life-threatening exacerbations.
- Distinguishing between severe therapy-resistant asthma and difficult-to-treat asthma, often influenced by comorbidities, is crucial for appropriate patient care.
Purpose of the Study:
- To highlight the importance of excluding common issues such as poor medication adherence, incorrect inhaler technique, and misdiagnosis before diagnosing severe asthma in children.
- To emphasize that difficult-to-treat asthma is more prevalent and manageable when comorbidities are addressed effectively.
Main Methods:
- Review of clinical guidelines and common diagnostic challenges in pediatric severe asthma.
- Emphasis on evaluating medication adherence, inhaler technique, and accurate diagnosis.
Main Results:
- Poor adherence, incorrect technique, and misdiagnosis are frequent reasons for persistent asthma symptoms and exacerbations.
- Difficult-to-treat asthma, when managed by addressing comorbidities, often shows improvement.
Conclusions:
- Children with persistent symptoms despite optimal adherence and technique require referral to a severe asthma specialist.
- Accurate diagnosis and management of comorbidities are essential for children with difficult-to-treat asthma.
Abstract:
Severe asthma in children is associated with significant morbidity. Children with severe asthma are at increased risk for adverse outcomes including medication-related side effects, life-threatening exacerbations, and impaired quality of life. It is important to differentiate between severe therapy resistant asthma and difficult-to-treat asthma due to comorbidities. The most common problems that need to be excluded before a diagnosis of severe asthma can be made are poor medication adherence, poor medication technique or incorrect diagnosis of asthma. Difficult to treat asthma is a much more common reason for persistent symptoms and exacerbations and can be managed if comorbidities are clearly addressed. Children with persistent symptoms and exacerbations despite correct inhaler technique and good medical adherence to standard Step 4 asthma therapies according to the guidelines1,2, should be referred to an asthma specialist with expertise in severe asthma.
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