Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Problematic, severe asthma in children: a new concept and how to manage it

Problematic, severe asthma in children: a new concept and how to manage it Problematic, severe asthma in children: a new concept and how to manage it Most children with asthma respond to low doses of inhaled corticosteroids, but a few remain symptomatic despite being prescribed the routine usual asthma medications. The first steps are to ensure that the diagnosis is correct and that the inhaled medications are being given regularly with an appropriately used device. If the children continue to be symptomatic, with any or all of chronic symptoms, acute exacerbations, the need for regular oral corticosteroids, or persistent airflow limitation, then they are considered to have problematic, severe asthma. The next step is to perform a detailed evaluation, including a nurse-lead home visit, to determine whether the child has difficult to treat asthma which improves if the basics are got right, or severe, therapy-resistant asthma ; the latter group would be candidates for cytokine-specific therapies. If severe, therapy-resistant asthma is the likely issue, then a detailed invasive investigation is performed, including bronchoscopy, bronchoalveolar lavage and endobronchial biopsy, and trial of adherence with a single intramuscular injection of depot triamcinolone. After detailed phenotyping, an individualised treatment plan is determined. Future work will determine the roles of proximal and distal inflammation, as well as the relative importance of intramural (mucosal) and intraluminal infection. The stability of paediatric asthma phenotypes over time is more variable than those of adults, and the implications of a change of phenotype are yet to be determined. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Acta Medica Lithuanica de Gruyter

Problematic, severe asthma in children: a new concept and how to manage it

Bush, Andrew
Acta Medica Lithuanica , Volume 17 – Jun 29, 2010
Download PDF
14 pages

Loading next page...
 
/lp/de-gruyter/problematic-severe-asthma-in-children-a-new-concept-and-how-to-manage-U9Rp4SJ8wQ
Publisher
de Gruyter
Copyright
Copyright © 2010 by the
ISSN
1392-0138
eISSN
2029-4174
DOI
10.2478/v10140-010-0007-7
Publisher site
See Article on Publisher Site

Abstract

Problematic, severe asthma in children: a new concept and how to manage it Most children with asthma respond to low doses of inhaled corticosteroids, but a few remain symptomatic despite being prescribed the routine usual asthma medications. The first steps are to ensure that the diagnosis is correct and that the inhaled medications are being given regularly with an appropriately used device. If the children continue to be symptomatic, with any or all of chronic symptoms, acute exacerbations, the need for regular oral corticosteroids, or persistent airflow limitation, then they are considered to have problematic, severe asthma. The next step is to perform a detailed evaluation, including a nurse-lead home visit, to determine whether the child has difficult to treat asthma which improves if the basics are got right, or severe, therapy-resistant asthma ; the latter group would be candidates for cytokine-specific therapies. If severe, therapy-resistant asthma is the likely issue, then a detailed invasive investigation is performed, including bronchoscopy, bronchoalveolar lavage and endobronchial biopsy, and trial of adherence with a single intramuscular injection of depot triamcinolone. After detailed phenotyping, an individualised treatment plan is determined. Future work will determine the roles of proximal and distal inflammation, as well as the relative importance of intramural (mucosal) and intraluminal infection. The stability of paediatric asthma phenotypes over time is more variable than those of adults, and the implications of a change of phenotype are yet to be determined.

Journal

Acta Medica Lithuanica – de Gruyter

Published: Jun 29, 2010

References

  • Symptomatic adrenal insufficiency presenting with hypoglycaemia in children with asthma receiving high dose inhaled fluticasone propionate
    A. Drake
  • Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom
    G. Todd
  • Azithromycin or montelukast as in haled corticosteroid-sparing agents in moderate-to-severe childhood asthma study
    R. Strunk
  • Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial
    S. Szefler
  • Daily telemonitoring of exhaled nitric oxide and symptoms in the treatment of childhood asthma
    J. de Jongste