Abstract
Both adults and children with severe asthma represent a small proportion of the asthma population; however, they consume disproportionate resources. For both groups it is important to confirm the diagnosis of severe asthma and ensure that modifiable factors such as adherence have, as far as possible, been addressed. Most children can be controlled on inhaled corticosteroids and long term oral corticosteroid use is rare, in contrast to adults where steroid related morbidity accounts for a large proportion of the costs of severe asthma. Atopic sensitization is very common in children with severe asthma as are other atopic conditions such as allergic rhinitis and hay fever which can impact on asthma control. In adults, the role of allergic driven disease, even in those with co-existent evidence of sensitization, is unclear. There is currently an exciting pipeline of novel biologicals, particularly directed at Type 2 inflammation, which afford the possibility of improved asthma control and reduced treatment side effects for people with asthma. However, not all drugs will work for all patients and accurate phenotyping is essential. In adults the terms T2 high and T2 low asthma have been coined to describe groups of patients based on the presence/absence of eosinophilic inflammation and T-helper 2 (TH2) cytokines. Bronchoscopic studies in children with severe asthma have demonstrated that these children are predominantly eosinophilic but the cytokine patterns do not fit the T2 high paradigm suggesting other steroid resistant pathways are driving the eosinophilic inflammation. It remains to be seen whether treatments developed for adult severe asthma will be effective in children and which biomarkers will predict response.
Highlights
Most children and adults diagnosed with asthma can achieve good symptom control on a low dose of correctly administered inhaled steroids with or without additional controller medication
There is overlap between the two there are a number of differences in clinical expression and disease mechanisms in children and adults
There remain a number of unmet needs in the management of severe asthma
Summary
Most children and adults diagnosed with asthma can achieve good symptom control on a low dose of correctly administered inhaled steroids with or without additional controller medication. There remains a small but significant proportion with ongoing symptoms and/or frequent attacks despite high intensity treatment. This group consume a high proportion of healthcare resources in terms of treatment costs and hospital admissions, as well as the wider societal costs of time of work and school. Severe Asthma and corticosteroid induced morbidity, in adults [1, 2]. In both adults and children, it is essential to firstly confirm the diagnosis of severe asthma in order to implement appropriate management. This article will outline the definition of severe asthma, before exploring the similarities and differences between adults and children in terms of demographics, pathophysiology and management
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