L’asthme sévère : les différents phénotypes

Abstract

Although recent data suggests that the prevalence of asthma is decreasing, the prevalence of severe asthma remains unchanged. Even if severe asthma affects only a minority of asthmatic children, this clinical form of asthma alone represents 80% of the health care expenses for asthma. The definition of severe asthma in children is difficult because current international classifications do not take into account severe exacerbations involving the lower airways. Excluding differential diagnoses, consideration of co-existing conditions, an inadequate environment and poor compliance to treatment are unavoidable factors which must be considered before making a diagnosis of severe asthma. The definition of the different phenotypes of severe asthma should take into account age of onset, the rate of recurrence of severe exacerbations and, finally, respiratory function. Allergic asthma continues to be a frequent phenomenon in paediatrics, with, on the one hand, the risk of severity and, on the other hand, the risk of persistence to adulthood. The importance of a better definition of “the severe asthmas” is that it would in the future allow better targeting of treatments such as omalizumab and humanized anti-IgE antibody, which are indicated in uncontrolled severe allergic asthma in school-aged children and adolescents.