Challenges in managing difficult‐to‐treat asthma in children: Stop, look, and listen

Abstract

It is recognized that asthma places a significant economic burden on the United States, with a total cost of $81.9 billion total costs including costs incurred by absenteeism and mortality. Severe asthma places a large burden of morbidity on children and their caregivers, including severe exacerbations, medication side effects, increased missed school days leading to impaired school performance, and lower caregiver quality of life. Therefore, we need to take a careful look at how we can make asthma care more efficient and cost effective, especially for those children with severe asthma. The 2019 American Thoracic Society symposium reported in this theme issue presented four aspects of managing severe asthma in children that merit attention including patient variables that affect severe asthma, understanding patient behaviors around medications, the appropriate use of bronchoscopy in diagnosis and management of severe asthma, and also the rational use of biologic therapy. This editorial will summarize key points in each of these reviews and prompt a more careful reading of each contribution.

Pediatric flexible bronchoscopy: A single‐center report

“… 40 When assessing children with asthma symptoms that are difficult to control, pediatric pulmonologists have to establish whether they really have asthma by excluding all the other conditions that may mimic asthma. 16 , 17 , 41 Several comorbidities of asthma or alternative diagnoses, such as trachea‐ and broncho‐malacia, central airway obstruction and/or compression, foreign body, or congenital airway malformations, can only be detected by FB. 17 In our cohort of patients with severe asthma who underwent FB, the majority (84.6%) had a normal airway anatomy, while 5 (12.8%) had central airway malacia or stenosis.…”

Biologic Therapies in Pediatric Asthma

“…Addressing severe asthma refractory to the basic therapeutic toolkit demands examining more advanced, innovative and steroid-sparing agents such as biologics [ 7 , 8 ]. Pediatric severe asthma accounts for a limited percentage of children with asthma, but it also counts for an extraordinarily excessive load of resource utilization and morbidity, even fatal reactions.…”

“…Airflow obstruction-inducing persistent symptoms, needing higher levels of controller therapy is the hallmark [ 10 ]. Its diagnosis involves a careful final assessment to exclude potent masquerading disorders accompanied by a differentiation between difficult-to-treat versus severe therapy resistant asthma (STRA) [ 7 , 8 ]. STRA is asthma that has persistently poor control even with the application of maximum standard therapies and control-based management that take modifiable risk factors into account.…”

Heliox for Pediatric Critical Asthma: A Multicenter, Retrospective, Registry-Based Descriptive Study

“…[1][2][3][4] Asthma is characterized by bronchospasm, inflammatory hypersecretion, increased airway resistance, and expiratory obstruction typically treated with systemic corticosteroids and bronchodilators. 5,6 In cases of critical asthma (CA), admission to the pediatric intensive care unit (PICU) offers enhanced monitoring and the provision of adjunctive pharmacologic (e.g. terbutaline and aminophylline) and non-invasive respiratory interventions (e.g.…”