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2014 ; 2
(5
): 489-500
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English Wikipedia
Severe asthma in children
#MMPMID25213041
Guilbert TW
; Bacharier LB
; Fitzpatrick AM
J Allergy Clin Immunol Pract
2014[Sep]; 2
(5
): 489-500
PMID25213041
show ga
Severe asthma in children is characterized by sustained symptoms despite
treatment with high doses of inhaled corticosteroids or oral corticosteroids.
Children with severe asthma may fall into 2 categories, difficult-to-treat asthma
or severe therapy-resistant asthma. Difficult-to-treat asthma is defined as poor
control due to an incorrect diagnosis or comorbidities, or poor adherence due to
adverse psychological or environmental factors. In contrast, treatment resistant
is defined as difficult asthma despite management of these factors. It is
increasingly recognized that severe asthma is a highly heterogeneous disorder
associated with a number of clinical and inflammatory phenotypes that have been
described in children with severe asthma. Guideline-based drug therapy of severe
childhood asthma is based primarily on extrapolated data from adult studies. The
recommendation is that children with severe asthma be treated with higher-dose
inhaled or oral corticosteroids combined with long-acting ?-agonists and other
add-on therapies, such as antileukotrienes and methylxanthines. It is important
to identify and address the influences that make asthma difficult to control,
including reviewing the diagnosis and removing causal or aggravating factors.
Better definition of the phenotypes and better targeting of therapy based upon
individual patient phenotypes is likely to improve asthma treatment in the
future.