Do not forget asthma comorbidities in pediatric severe asthma!

Abstract

Asthma is the most common chronic respiratory disease in childhood. The long-term goals in managing asthma aim to control symptoms and prevent exacerbations, as well as to reduce side effects of therapy and mortality disease-related. Most of patients have mild to moderate asthma and respond well to standard therapies. However, a minor proportion of children with asthma has severe disease that remains uncontrolled despite optimal adherence to prescribed therapy and treatment of contributory factors, including trigger exposures and comorbidities, which can mimic or worsen asthma and contribute to exacerbations and poor quality of life. Evaluation of comorbidities is fundamental to optimize the management of the disease in a subgroup of patients with poor responder asthma. The overall aim of this article is to describe characteristics of main pediatric severe asthma comorbidities reported in literature, giving clinicians tools to recognize and manage properly these conditions.

Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO

“…This is consistent with all current asthma guidelines, including Global Initiative for Asthma (GINA) 6 and National Asthma Education and Prevention Program (Expert Panel Report 3, EPR‐3) 16 . It reflects good clinical practice (symptom and sign evaluation, which includes physical examination), the current philosophy of asthma management (based on disease control and prevention of exacerbations), and strong evidence demonstrating the role of comorbidities in adverse asthma outcomes 20,21 …”

“…16 It reflects good clinical practice (symptom and sign evaluation, which includes physical examination), the current philosophy of asthma management (based on disease control and prevention of exacerbations), and strong evidence demonstrating the role of comorbidities in adverse asthma outcomes. 20,21…”

Progress in diagnosis and treatment of difficult-to-treat asthma in children

“… 111 The relationship between these two conditions is bidirectional, meaning that obesity can result from asthma, and asthma can also be brought on by obesity. 13 However, in children with asthma, obesity is linked to decreased asthma control and lung function, a lower quality of life, and a higher risk of asthma attacks. 112 Obesity is a known risk factor for increased hospitalizations in the pediatric intensive care unit.…”

“… 134 In children with asthma, there is limited evidence as to whether such treatment is feasible. 13 The management of asthma, quality of life, and exacerbation risk may be optimized by breathing control exercises with the assistance of a skilled physiotherapist. 24 In a cohort study of 169 children with asthma and DB, it was found that, in addition to conventional medical therapy, individually tailored physical therapy interventions, namely Buteyko Breathing methods, improved asthma control and DB in kids receiving all levels of asthma medication.…”

“… 11 DA imposes a high morbidity rate with significant social burden and healthcare resource utilization. 12 , 13 Indeed, the medical expenses of children with DA account for 30–50% of the total medical expenses of all asthmatic children. 14 Beyond the financial cost, DA patients’ quality of life and academic performance might suffer dramatically because of the increased risk of exacerbations and hospitalization.…”