PT  - JOURNAL ARTICLE
AU  - K.C. Lødrup Carlsen
AU  - G. Hedlin
AU  - A. Bush
AU  - G. Wennergren
AU  - F.M. de Benedictis
AU  - J.C. De Jongste
AU  - E. Baraldi
AU  - C. Pedroletti
AU  - A. Barbato
AU  - K. Malmström
AU  - P. Pohunek
AU  - S. Pedersen
AU  - G.L. Piacentini
AU  - R.J.M. Middelveld
AU  - K.H. Carlsen
TI  - Assessment of problematic severe asthma in children
AID  - 10.1183/09031936.00091410
DP  - 2011 Feb 01
TA  - European Respiratory Journal
PG  - 432--440
VI  - 37
IP  - 2
4099  - http://erj.ersjournals.com/content/37/2/432.short
4100  - http://erj.ersjournals.com/content/37/2/432.full
SO  - Eur Respir J2011 Feb 01; 37
AB  - 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.