Related Experiment Video
Updated: Aug 6, 2026
Dry Powder and Nebulized Aerosol Inhalation of Pharmaceuticals Delivered to Mice Using a Nose-only Exposure System
Published on: April 6, 2017
Prevalence and Incidence of Difficult-to-Treat Asthma in Children Between 2010 and 2020: Promise and Pitfalls of
V Perugini1, J K Quint2, L Fleming3
1Respiratory Effectiveness Group, Cambridgeshire, United Kingdom.
Insights
This study found that 13.1-15.7 per 1,000 children have difficult to treat asthma (DTTA). High short-acting beta-agonist (SABA) use and low adherence indicate a need for better asthma management strategies.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Epidemiology
Background:
- Difficult to treat asthma (DTTA) prevalence is unclear due to limited data and varied definitions.
- Accurate assessment of DTTA burden in pediatric populations is challenging.
Purpose of the Study:
- To determine the prevalence of DTTA in children using three distinct definitions.
- To assess DTTA incidence, high short-acting beta-agonist (SABA) use, and eligibility for biological therapies in a large pediatric cohort.
Main Methods:
- Retrospective cohort study of children aged 3-15 years (2010-2020) using primary care prescribing data.
- Applied three guideline-based definitions for DTTA and NICE criteria for biological therapy eligibility.
- Defined high SABA use (>3 canisters/year) and adequate adherence (>80% controller possession).
Main Results:
- DTTA prevalence ranged from 13.1-15.7 per 1,000 children, highest in 2010.
- Annual DTTA incidence was 4.7-7.6 per 1,000 children with asthma.
- 68% of children (6-15 years) with asthma had high SABA use; 1.6% were potentially eligible for biologics, but only 4% were adherent.
Conclusions:
- Primary care data can identify potential pediatric DTTA cases, though prevalence may be overestimated, necessitating clinical review.
- High SABA use and low adherence highlight significant opportunities for improved asthma management.
- Targeted digital monitoring and data-driven approaches can enhance asthma care for children.
Background:
Limited whole-population data and heterogeneous definitions complicate efforts to describe the burden of difficult-to-treat asthma (DTTA).
Objective:
To determine the prevalence of DTTA in a large population of children using three different definitions and assess the incidence of DTTA, prevalence of high short-acting β-agonist (SABA) use, and potential eligibility for biologic therapies.
Methods:
This was a retrospective cohort study using primary care prescribing data from 3- to 15-year-olds between 2010 and 2020. We defined DTTA using three international guideline-based definitions. High SABA use was defined as more than three canisters annually. Adequate adherence was defined as a controller medication possession rate greater than 80%. We used National Institute for the Health and Care Excellence criteria to estimate eligibility for biologic therapies.
Results:
Among 2,364,000 children, 127,921 had asthma (mean age 7.2 years; 61% male). The prevalence of DTTA was between 13.1 and 15.7 per 1,000 children, depending on the definition applied, with the highest prevalence in 2010. The annual DTTA incidence among 6-to-15-year-olds varied between 4.7 and 7.6 per 1,000 children with preexisting asthma. High SABA use among 6- to 15-year-olds was observed in 68% of all children with asthma. Before adherence to preventer therapy was considered, 1.6% of all children with asthma were potentially eligible for biologic therapies, but only 4% of these were judged to be adherent.
Conclusions:
Prescribing data can identify children with potential DTTA and should prompt clinical review, but they may overestimate prevalence. High short-acting β-agonist use and low adherence highlight opportunities for improved asthma management through targeted digital monitoring and data-driven approaches.
Related Concept Videos
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:02Prescription, Nonprescription and Orphan Drugs
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:23Inhaled Medications
01:29Asthma-I: Introduction
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...