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Updated: Oct 11, 2025
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Difficult-to-Treat Asthma Management in School-Age Children
Andy Bush1, Anne M Fitzpatrick2, Sejal Saglani3
1Director, Imperial Centre for Paediatrics and Child Health, Professor of Paediatrics and Paediatric Respirology, National Heart and Lung Institute, Imperial College, Consultant Paediatric Chest Physician, Royal Brompton Hospital, London, United Kingdom.
Insights
Severe asthma affects about 5% of children with asthma. Identifying specific phenotypes is key to personalized treatment, potentially using biologics and digital health to improve outcomes and prevent severe disease.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Digital Health
Background:
- Severe asthma is categorized by the WHO into untreated, difficult-to-treat, and therapy-resistant types.
- Approximately 5% of children with asthma have severe asthma, requiring careful diagnosis and management.
- Objective biomarkers are crucial for identifying pathophysiologic phenotypes in severe asthma.
Purpose of the Study:
- To emphasize the importance of accurate asthma diagnosis and phenotype identification in children.
- To explore alternative treatment approaches, including biologics, for difficult-to-treat asthma.
- To highlight the potential of digital health in monitoring and managing severe asthma.
Main Methods:
- Review of World Health Organization classifications for severe asthma.
- Discussion of diagnostic evaluation and phenotype identification using biomarkers.
- Exploration of advanced treatment strategies, including biologics and digital health tools.
Main Results:
- Severe asthma represents a significant subset of pediatric asthma cases.
- Phenotypic characterization is essential for tailoring treatment in severe asthma.
- Novel therapies like biologics and digital health offer promising avenues for improved management.
Conclusions:
- Accurate diagnosis and phenotypic assessment are critical for managing severe pediatric asthma.
- Biologics and digital health innovations hold potential for personalized treatment and improved patient outcomes.
- Future strategies should focus on individualized treatment, enhanced monitoring, and prevention of severe asthma progression.
Abstract:
The World Health Organization divides severe asthma into three categories: untreated severe asthma; difficult-to-treat severe asthma; and severe, therapy-resistant asthma. The apparent frequency of severe asthma in the general population of asthmatic children is probably around 5%. Upon referral of these children, it is important to evaluate the diagnosis of asthma carefully before modifying management and applying a long-term monitoring plan. Identification of pathophysiologic phenotypes using objective biomarkers is essential in our routine assessments of severe asthma. Although conventional pharmacologic approaches should be attempted first, there is growing recognition that children with difficult-to-treat asthma may have unique clinical phenotypes that may necessitate alternative treatment approaches including asthma biologics. These new medications, especially those with effects on multiple pathologic features of asthma, raise the hope that new treatment strategies could induce remission. Besides introducing new medications, the opportunity for closer monitoring is feasible with advances in digital health. Therefore, we have the opportunity to improve response to medications, individualize treatment, and monitor response along with potential steps to prevent severe asthma.
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