Abstract
Assessment of problematic severe asthma in children should be performed in a step-wise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi-disciplinary assessment is performed to identify issues that may need attention, including comorbidities. Thirdly, the pattern of inflammation is assessed, and finally steroid responsiveness is documented.
Based upon these four steps an optimal individualised treatment plan is developed. In this article the many gaps in our current knowledge in all these steps are highlighted, and recommendations for current clinical practice and future research are made.
The lack of good data and the heterogeneity of problematic severe asthma still limit our ability to optimise the management on an individual basis in this small, but challenging group of patients.
Footnotes
Previous articles in this Series: No. 1: Hedlin G, Bush A, Lødrup Carlsen K, et al. Problematic severe asthma in children, not one problem but many: a GA2LEN initiative. Eur Respir J 2010; 36: 196–201. No. 2: Xepapadaki P, Papadopoulos NG. Childhood asthma and infection: virus-induced exacerbations as determinants and modifiers. Eur Respir J 2010; 36: 438–445. No. 3: de Groot EP, Duiverman EJ, Brand PLP. Comorbidities of asthma during childhood: possibly important, yet poorly studied. Eur Respir J 2010; 36: 671–678. No. 4: Kabesch M, Michel S, Tost J. Epigenetic mechanisms and the relationship to childhood asthma. Eur Respir J 2010; 36: 950–961.
Support Statement
This article was initiated and financially supported by the Global Allergy and Asthma European Network (GA2LEN; EU contract number FOOD-CT-2004-506378).
Statement of Interest
Statements of interest for G. Hedlin, G. Wennergren, F.M. de Benedictis, J.C. de Jongste, E. Baraldi, G.L. Piacentini and K.H. Carlsen can be found at www.erj.ersjournals.com/site/misc/statements.xhtml
- Received June 14, 2010.
- Accepted September 18, 2010.
- ©ERS 2011