S3.3: Dealing With Difficult Asthma
Year: 2011
Type: article
Abstract: Majority of patients with asthma have mild or moderate disease, and can achieve reasonable asthma control by the regular use of anti-inflammatory and bronchodilating medications. A small subset of asthmatic (5-8%) patients remained symptomatic and suffered from frequent exacerbations or persistent airflow limitation despite the use of maximal doses of inhaled medication. Even though it accounts for a small proportion of all asthma in childhood, but it consumes a disproportionate amount of healthcare resources, and leads to substantial morbidity and even premature death. These groups of asthmatic patients were known as severe/difficult-to-treat/therapy resistant/steroid dependent asthma. ERS Task Force 1999 defined difficult asthma as asthma, poorly controlled in terms of chronic symptoms, with episodic exacerbations, persistent and variable airway obstruction and continued requirement for short-acting beta2 agonists and high doses of inhaled corticosteroids. These patients who were diagnosed to have difficult to treat asthma should undergone detail evaluation including detail history, examination and investigations to exclude other diagnosis and co-morbid conditions. Only half of the patients who were labeled as difficult to treat asthma actually have severe asthma. The other half of the patients symptoms were able to be controlled after the technique of inhalation was corrected, co-morbid conditions were treated, and continuous exposure to allergen was avoided. Some of the cases had other underlying conditions which mimics asthma symptoms. Treatment for severe childhood asthma should follow local guideline, GINA or PRACTALL guidelines. There are not many evidence-based treatments for severe childhood asthma available currently. Approach to difficult to treat childhood asthma and the available evidence-based treatments will be discussed.
Author: Rus Anida Awang
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W159483270