RT Journal Article
SR Electronic
T1 Problematic severe asthma in children: A nationwide study in The Netherlands
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P4567
VO 40
IS Suppl 56
A1 Annemie L.M. Boehmer
A1 Liesbeth van Essen
A1 Eric Duiverman
A1 Johan de Jongste
A1 Ad Bosschaart
A1 Cindy Hugen
A1 Eric-Jonas van de Griendt
A1 Florens Versteegh
A1 Bart van Ewijk
A1 Anneke Landstra
A1 Jeanette Dankert-Roelse
A1 Karin de Winter
A1 Hein Brackel
A1 Anja Vaessen-Verberne
A1 Marianne Brouwer
A1 Govert Brinkhorst
A1 Rein Jöbsis
A1 The Dutch PSA Study Group
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/P4567.abstract
AB Introduction: Epidemiological data on problematic severe asthma in children are sparse. Methods: A 3 year (2008-2011), nationwide survey on PSA in children 4-18yrs old in the Netherlands through a national surveillance system among all paediatricians. Results: In this cross sectional study 328 children, aged 4-18yrs with PSA, were identified. A prevalence of at least 0.01% of children with asthma. PSA is more frequent in boys than in girls under 12yrs old. This sex ratio reverses >12yrs old. Eighty-five% had allergic asthma and in 85% symptoms started before they were 4yrs old. Investigations included lung function, FeNO, trials of steroids, chest radiographs, sweat tests, immunodiagnostics, HRCT, bronchoscopy in various percentages of patients. Over 10% had 5-13 exacerbations requiring prednisolon in the past year. ICU admittance in 11%. Fifty% had exacerbations with no symptoms in between, 40% suffered from very acute asthma attacks and 30% were continuously symptomatic. All despite up-to-date intensive surveillance and treatment. Seventy-five% received psycho diagnostics and 50% psychotherapy. FEV1 was normal in 85% of patients. Persistent airflow limitation in the past year was present in 13%. Daily prednisolon, omalizumab or antiTNFalfa was used in resp 5%, 1% and 0,08%. Conclusions: PSA in a country with a high standard medical system and coverage of medical cost for all, is rare. Asthma symptoms in children with PSA start <4yrs old. Children have severe symptoms despite intensive treatment and follow-up. Daily ICS doses are high with additional frequent oral steroids courses. Follow-up of this cohort into adulthood will yield the natural course of symptoms, lungfunction and psychosocial problems.