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Evaluating Severe Therapy-Resistant Asthma in Children: Diagnostic and Therapeutic Strategies
1Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Insights
Optimizing asthma management is key, especially for severe cases. While new biologic therapies offer hope for therapy-resistant asthma, mastering foundational treatments remains crucial for most patients.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Asthma is a prevalent global respiratory disease causing significant morbidity.
- Effective treatment for most asthma patients relies on correct and regular medication use.
- Approximately 10% of asthma patients have uncontrolled disease or require high-dose medications, leading to high healthcare costs.
Purpose of the Study:
- To review the definition, management, and pharmacotherapy of severe asthma.
- To discuss the World Health Organization (WHO) classification of severe asthma and its treatment levels.
- To outline strategies for managing patients with difficult-to-treat asthma.
Main Methods:
- Literature search of PubMed and personal archives for severe asthma research.
- Analysis of WHO classification and treatment guidelines for severe asthma.
- Review of multidisciplinary team assessment protocols for optimizing basic asthma management.
Main Results:
- Many patients referred for advanced therapy can be managed with optimized standard treatments after multidisciplinary assessment.
- For true therapy-resistant asthma, options include monoclonal antibodies targeting type 2 inflammation.
- Significant gaps remain in understanding and treating non-eosinophilic severe asthma.
Conclusions:
- Correctly implementing foundational asthma care is paramount.
- Biologic therapies, such as monoclonal antibodies, represent a significant advancement for severe, therapy-resistant asthma.
- Further research is needed to address the limited treatment options for non-eosinophilic asthma.
Abstract:
Introduction: Worldwide, asthma is the most common non-communicable respiratory disease and causes considerable morbidity and mortality. Most people with asthma can be treated effectively with low-dose medications if these are taken correctly and regularly. Around 10% of people with asthma have an uncontrolled form of the disease or can only achieve control with high-dose medications, incurring disproportionately high health care costs. Areas Covered: PubMed and personal archives were searched for relevant articles on the definition, management and pharmacotherapy of severe asthma. The WHO classification of severe asthma and the treatment levels encompassed in the definition are discussed. Most children and young people referred for consideration of 'beyond-guidelines therapy' can in fact be managed on standard treatment after a multi-disciplinary team assessment focusing on ensuring correct basic management, and these steps are described in detail. Options for those with true therapy-resistant asthma are described. These include monoclonal antibodies, most of which target type 2 inflammation. Expert Opinion: Getting the basics right is still the most important aspect of asthma care. For those with severe, therapy-resistant asthma, an increasing number of life-transforming monoclonals have been developed, but there is still little understanding of, and a paucity of treatment options for, non-eosinophilic asthma.
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