Related Experiment Video
Updated: Dec 9, 2025
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
An approach to the management of children with problematic severe asthma
Valentina Fainardi1, Sejal Saglani2
1Cystic Fibrosis Unit, Children University Hospital, Parma. valentina.fainardi@gmail.com.
Insights
Problematic severe asthma in children often improves with adherence to inhaled corticosteroids and addressing lifestyle factors. Persistent symptoms despite these interventions indicate severe therapy-resistant asthma requiring specialized management.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Problematic severe asthma affects children with poor control despite high treatment levels.
- Distinguishes between difficult-to-treat and severe therapy-resistant asthma based on response to interventions.
Purpose of the Study:
- To describe a 6-step diagnostic and management approach for problematic severe asthma in children.
- To highlight the role of a multidisciplinary team in managing these complex cases.
Main Methods:
- Review of a 6-step diagnostic and management protocol.
- Emphasis on identifying and treating modifiable factors (inhalation technique, environment, psychosocial issues).
- Discussion of the role of multidisciplinary teams and current add-on therapies.
Main Results:
- Most children with problematic severe asthma have steroid-sensitive disease.
- Addressing modifiable factors is key to improving control in difficult-to-treat asthma.
- Severe therapy-resistant asthma requires further investigation and management strategies.
Conclusions:
- A structured, multidisciplinary approach is crucial for diagnosing and managing problematic severe asthma in children.
- Identifying and treating modifiable factors can prevent unnecessary investigations and treatments.
- Further understanding of add-on therapies is needed for severe therapy-resistant asthma.
Abstract:
Children with poor asthma control despite high levels of prescribed treatment are described as having problematic severe asthma. Most of these children have steroid sensitive disease which improves with adherence to daily inhaled corticosteroids and after having removed modifiable factors like poor inhalation technique, persistent adverse environmental exposures and psychosocial factors. These children are described as having "difficult-to-treat asthma" while children with persistent symptoms despite above-mentioned factors having been addressed are described as having "severe therapy-resistant asthma". In this review, we will describe the 6-step approach to the diagnosis and management of a child with problematic severe asthma adopted by The Royal Brompton Hospital (London, UK). The role of a multidisciplinary team is crucial for identification and treatment of modifiable factors and comorbidities in order to avoid invasive examinations and useless pharmacological treatments. The current knowledge on add-on therapies will be discussed.
Related Concept Videos
01:30Asthma-IV: Nursing Management
First, in...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
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.
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:29Asthma-I: Introduction
01:26COPD: Management Using Bronchodilators and Corticosteroids