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Approach to difficult-to-treat asthma in childhood: a narrative review
Duo-Tong Cheng1, Liang Yi Justin Wee, Oon Hoe Teoh
1Department of Paediatrics, Respiratory Medicine Service, KK Women's and Children's Hospital, Singapore.
Insights
This review focuses on managing difficult-to-treat pediatric asthma. Personalized strategies, addressing comorbidities, and adherence are key to improving asthma control in children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Difficult-to-treat asthma in children significantly impacts healthcare resources.
- Accurate diagnosis and management are crucial for effective treatment.
Purpose of the Study:
- To provide an updated overview of treatment strategies for difficult-to-treat pediatric asthma.
- To emphasize personalized approaches and the role of biologics.
Main Methods:
- Comprehensive literature review of current treatment guidelines and research.
- Analysis of factors influencing asthma control in children.
- Evaluation of diagnostic criteria and management of comorbidities.
Main Results:
- Ruling out asthma mimics and confirming diagnosis with objective tests are essential.
- Comorbidities like obesity, smoking, and psychosocial factors must be considered.
- Personalized treatment, adherence monitoring, and appropriate drug delivery are vital.
Conclusions:
- Biologics are an option for select patients but do not replace adherence improvement.
- Many cases of difficult-to-treat asthma are not severe asthma.
- An individualized approach involving physicians, patients, and families is key to achieving good asthma control.
Abstract:
Asthma is a major chronic disease affecting children, and children with difficult-to-treat asthma account for a disproportionate share of resource utilisation and healthcare costs. This review presents a comprehensive and up-to-date overview of the treatment strategies in difficult-to-treat paediatric asthma. Mimickers of asthma must first be ruled out, and the diagnosis confirmed with objective tests whenever possible. The effect of comorbid conditions such as obesity, smoking, other atopic conditions and psychosocial factors on asthma control and severity should be considered. Treatment can then be optimised by implementing personalised strategies, including the use of appropriate drug delivery devices and adherence monitoring. Biologics can be an alternative treatment option for selected patients but should not be a substitute for addressing poor adherence. Many patients with difficult-to-treat asthma may not have severe asthma, and the physician should work with patients and families to achieve good asthma control via an individualised approach.
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