Problematic severe asthma: A proposed approach to identifying children who are severely resistant to therapy
- 30 September 2010
- journal article
- research article
- Published by Wiley in Pediatric Allergy and Immunology
- Vol. 22 (1-Part-I), 9-18
- https://doi.org/10.1111/j.1399-3038.2010.01098.x
Abstract
Children with problematic severe asthma (PA) are either difficult to treat because of the presence of aggravating factors or else severely resistant to therapy. We investigated a cohort of school-aged children with PA and compared these children to age-matched peers with controlled persistent asthma (CA). The aims were to characterize features of children suffering from PA and identify children who were severely resistant to therapy. In this cross-sectional, multicenter comparison of children with different manifestations of persistent asthma, PA was defined as insufficient asthma control despite level 4 treatment, according to GINA. The protocol included questionnaires, spirometry, methacholine provocation, measurement of fraction of nitric oxide in exhaled (FE(NO) ) and nasal air, blood sampling for inflammatory biomarkers and atopy, and computerized tomography of sinuses and lungs (in the PA group only). Of the 54 children with PA, 61% had therapy-resistant asthma, with the remaining being difficult to treat because of identified aggravating factors. Children with PA more often had parents with asthma (p=0.003), came from families with a lower socioeconomic status (p=0.01), were less physically active (p=0.04), and had more comorbidity with rhinoconjunctivitis (p=0.01) than did the 39 children with CA. The former also exhibited lower FEV(1) values (p=0.02) and increased bronchial hyper-responsiveness (p=0.01), but there were no differences in atopy (p=0.81) or FE(NO) (p=0.16). A non-invasive protocol, involving a standardized and detailed clinical characterization, revealed distinguishing features of children with PA and enabled the identification of children with therapy-resistant asthma.Keywords
This publication has 25 references indexed in Scilit:
- Problematic severe asthma in children, not one problem but many: a GA2LEN initiativeEuropean Respiratory Journal, 2010
- Predictors of remitting, periodic, and persistent childhood asthmaJournal of Allergy and Clinical Immunology, 2010
- Identifying problematic severe asthma in the individual child – does lung function matter?*Acta Paediatrica, 2010
- The unbearable cost of severe asthma in underprivileged populationsAllergy, 2009
- High prevalence and young onset of allergic rhinitis in children with bronchial asthmaPediatric Allergy and Immunology, 2008
- Severe asthma in childhood: assessed in 10 year olds in a birth cohort study*Allergy, 2008
- Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxideJournal of Allergy and Clinical Immunology, 2006
- Asthma in every fifth child in Oslo, Norway: a 10‐year follow up of a birth cohort study*Allergy, 2006
- Mechanisms of severe asthmaClinical and Experimental Allergy, 2003
- Rhinosinusitis in severe asthmaJournal of Allergy and Clinical Immunology, 2001