The approach to a child with severe asthma

Authors

  • Blaženka Kljaić Bukvić Odjel za pedijatriju OB Dr. Josip Benčević, Ulica Andrije Štampara 42, 35000 Slavonski Brod Fakultet za dentalnu medicinu i zdravstvo, Sveučilišta Josipa Jurja Strossmayera u Osijeku, Crkvena 21, 31 000 Osijek Medicinski fakultet Osijek, Sveučilišta Josipa Jurja Strossmayera u Osijeku, Josipa Huttlera 4, 31 000 Osijek
  • Irena Ivković-Jureković Odjel za pulmologiju, alergologiju, imunologiju i reumatologiju, KDB Zagreb, Klaićeva 16, 10 000 Zagreb Fakultet za dentalnu medicinu i zdravstvo, Sveučilišta Josipa Jurja Strossmayera u Osijeku, Crkvena 21, 31 000 Osijek Medicinski fakultet Sveučilišta u Zagrebu, Šalata 3, 10 000 Zagreb
  • Marta Navratil Odjel za pulmologiju, alergologiju, imunologiju i reumatologiju, KDB Zagreb, Klaićeva 16, 10 000 Zagreb Medicinski fakultet Osijek, Sveučilišta Josipa Jurja Strossmayera u Osijeku, Josipa Huttlera 4, 31 000 Osijek
  • Marijana Rogulj Zavod za pulmologiju s alergologijom i kardiologiju s reumatologijom, Klinika za dječje bolesti, KBC Split, Spinčićeva 5, 21 000 Split, Medicinski fakultet, Sveučilište u Splitu, Šoltanska 2, 21 000 Split
  • Davor Bandić Odjel za pedijatriju NMB Vukovar, Županijska 35, 32 000 Vukovar
  • Jadranka Kelečić Zavod za kliničku imunologiju, respiracijske i alergološke bolesti i reumatologiju, Klinika za pedijatriju, KBC Zagreb, Kišpatićeva 12, 10 000 Zagreb Medicinski fakultet Sveučilišta u Zagrebu, Šalata 3, 10 000 Zagreb
  • Silvije Šegulja Zavod za kardiologiju, pulmologiju, reumatologiju, alergologiju i imunologiju, Klinika za pedijatriju, KBC Rijeka, Istarska 43, 51 000 Rijeka, Fakultet zdravstvenih studija, Sveučilište u Rijeci, Viktora Cara Emina 5, 51 000 Rijeka
  • Darko Richter Poliklinika DermaPlus, Kaptol 25, Zagreb

Keywords:

ASTHMA, CHILD

Abstract

Severe asthma is considered a complex and heterogeneous disease, which includes different phenotypes, defined in terms of both clinical and molecular characteristics and underlining endotypes. It is estimated that severe asthma affects 2-5% of all children with asthma. It occurs more frequently in children older than ten years of age, with a slight prevalence among the male sex. Although severe asthma is uncommon, this group of children has an increased risk of drug side effects and life-threatening exacerbations that impair quality of life. Also, the financial burden from medication, scheduled and unscheduled doctor visits, hospitalizations and absence from school and work by parents have to be considered. There is no uniform definition of severe asthma, but the common characteristic is the need for maximal maintenance therapy, including high-dose inhaled steroids, long-acting beta-agonists, and/ or leukotriene receptor antagonists/theophylline. Despite the highest doses of maintenance therapy, patients with severe asthma fail to control the disease. Uncontrolled asthma has to be re-evaluated by confirming the diagnosis and modifying factors contribut- ing to symptoms and exacerbations like poor adherence, environmental risks (persistent allergen and pollutant exposure) and co- morbidities (upper airway disease, gastroesophageal reflux, obesity, anxiety). Children with poor asthma control due to misdiagnosed asthma, poor adherence or environmental risks have difficult-to-treat asthma, whereas children who still have poor control despite re-education to improve adherence and modification of environmen- tal risks have severe, therapy-resistant asthma. The approach to children with difficult-to-treat-asthma, which includes systematic evaluation and acting on modifying factors, enables achieving the long-term goals of asthma treatment in approximately two-thirds of patients. The remaining children, whose asthma is still uncontrolled despite optimized therapy, have severe, therapy-resistant asthma. Those children are candidates for bio- logical treatment based on the determination of phenotypic features.

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Published

2022-06-30

Issue

Section

Review

How to Cite

Bukvić, B. K., Ivković-Jureković, I., Navratil, M., Rogulj, M., Bandić, D., Kelečić, J., Šegulja, S., & Richter, D. (2022). The approach to a child with severe asthma. Paediatria Croatica, 67(1-2), 16-22. https://journal.paedcro.com/index.php/paedcro/article/view/364

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