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.
Highlights
Asthma is the most frequent chronic inflammatory disease of the lower airways that affects 4.4%of preschoolers and 6.4% of primary school children [1] and is responsible for significant social and economic burdens [2].Good control of symptoms is usually achieved with low doses of inhaled corticosteroids (ICS), and only a small proportion of asthmatics need high doses of ICS, long-acting β2-agonists (LABA), and leukotriene antagonists to achieve symptom control [3]
As the management of children with poor control of asthma symptoms still represents a clinical challenge to pediatricians, we carried out a literature review to provide an overview of the definition of difficult and severe asthma and their respective strategies of treatment
Its use is recommended in adults and children (≥6 years) with moderate-to-severe chronic allergic asthma, increase total IgE
Summary
Asthma is the most frequent chronic inflammatory disease of the lower airways that affects 4.4%. In 2008, the concept of “problematic severe asthma” was suggested to indicate children not responding to high doses of asthma medications [4]. Ten years later, this concept was revised as it was considered reductive, being based solely on prescribed treatment levels [5]. As the management of children with poor control of asthma symptoms still represents a clinical challenge to pediatricians, we carried out a literature review to provide an overview of the definition of difficult and severe asthma and their respective strategies of treatment
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