Assessment of problematic severe asthma in children: Figure 1–

Abstract

on behalf of the PSACI (Problematic Severe Asthma in Childhood Initiative) group ABSTRACT: Assessment of problematic severe asthma in children should be performed in a stepwise 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.

Severe asthma in children—a review of definitions, epidemiology, and treatment options in 2019

“…The uncertainties surrounding the diagnosis and management of severe childhood asthma have been reviewed on a regular basis . The aims of this review are (i) to describe the different definitions of severe asthma and to identify which components are common to all and which are not consistently included, (ii) to describe the epidemiology of severe asthma and (iii), knowing that the benefits and harm from commonly used inhaler medications and oral montelukast are described elsewhere, our final aim was to review the evidence of benefit and harm from the systemic medications currently used in severe asthma.…”

“…Faced with a child or adolescent with a possible severe asthma diagnosis, clinicians need to consider possibilities, which are more fully described elsewhere and summarized here: Is this asthma?…”

The oral corticosteroid-sparing effect of omalizumab in children with severe asthma

“…Children with symptoms that do not respond adequately to treatment should be referred to specialist paediatric respiratory services for further investigation and management 3 4. Following critical re-examination of the diagnosis and addressing of the basics of asthma management, including a nurse-led home visit, a group of children remain who have genuinely severe disease that does not respond to standard approaches 5–7. Many such children require maintenance treatment with oral corticosteroids, which is associated with considerable adverse effects 8 9…”

Severe Chronic Allergic (and Related) Diseases: A Uniform Approach – A MeDALL – GA²LEN – ARIA Position Paper

“…Phenotypes of severe problematic asthma differ in children and in adults [120,121]. A proposal with a 4-step procedure for the diagnosis and assessment of severe problematic asthma in childhood has recently been published [122]. The steps include: (a) a full diagnostic work-up that may exclude other chronic lung diseases which may mimic severe asthma; (b) a multidisciplinary assessment to identify factors of importance including comorbidities; (c) an assessment of the pattern of inflammation, and (d) a documentation of the level of corticosteroid responsiveness.…”