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Difficult and Severe Asthma in Children
Federica Porcaro1, Nicola Ullmann1, Annalisa Allegorico1
1Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, and Genetic Research Area, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Insights
Pediatric asthma management requires careful assessment to distinguish difficult-to-control asthma from severe therapy-resistant asthma. Identifying and addressing modifiable factors early improves outcomes for difficult asthma cases.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Pediatrics
Background:
- Asthma is a prevalent chronic lower airway inflammatory disease in children, posing ongoing challenges for pediatricians.
- While most pediatric asthma patients achieve symptom control with standard treatments, a subset experiences persistent, uncontrolled asthma.
Purpose of the Study:
- To outline the necessity of a multidisciplinary assessment for children with uncontrolled persistent asthma.
- To emphasize the importance of differentiating difficult asthma from true severe therapy-resistant asthma.
Main Methods:
- Systematic assessment encompassing comorbidities, treatment adherence, environmental exposures, and psychosocial factors.
- Identification of modifiable factors contributing to asthma severity.
Main Results:
- Distinguishing difficult asthma from severe therapy-resistant asthma is crucial for appropriate management.
- Early intervention on modifiable factors can enhance control in difficult asthma cases, potentially avoiding invasive procedures.
Conclusions:
- A thorough, multidisciplinary evaluation is essential for children with uncontrolled asthma.
- Accurate diagnosis of severe therapy-resistant asthma ensures timely access to advanced biological therapies and avoids treatment delays.
Abstract:
Asthma is the most frequent chronic inflammatory disease of the lower airways affecting children, and it can still be considered a challenge for pediatricians. Although most asthmatic patients are symptom-free with standard treatments, a small percentage of them suffer from uncontrolled persistent asthma. In these children, a multidisciplinary systematic assessment, including comorbidities, treatment-related issues, environmental exposures, and psychosocial factors is needed. The identification of modifiable factors is important to differentiate children with difficult asthma from those with true severe therapy-resistant asthma. Early intervention on modifiable factors for children with difficult asthma allows for better control of asthma without the need for invasive investigation and further escalation of treatment. Otherwise, addressing a correct diagnosis of true severe therapy-resistant asthma avoids diagnostic and therapeutic delays, allowing patients to benefit from using new and advanced biological therapies.
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