Half of severe asthma cases in children are not untreatable; just follow the basics

Half of severe asthma cases in children are not untreatable; just follow the basics

Many youths appear resistant to treatment from the onset of a severe asthmatic condition. Why? Simply put, many have been wrongly diagnosed or caretakers have not followed asthma treatment guidelines properly.

There is no one cure-all for this condition that is a chronic, or long-term lung disease that inflames and narrows the airways. Although treatment techniques have advanced considerably, a review in this week's European Respiratory Society meeting special edition of The Lancet, plainly states that the best method of successful management of asthma is via a multidisciplinary approach that can be handled with standard well-known therapies in more than 50% of children having trouble breathing.

Unfortunately, severe asthma containment has been based on limited research. Surprisingly, no randomized trials of treatment in children even exist.

Serious recommendations were obviously needed for the public, so Andrew Bush and Sejal Saglani from Imperial College London and the Royal Brompton Harefield NHS Foundation Trust examined already published papers concerning adults with severe asthma and children with mild-to-moderate asthma. Including data from personal professional practice in the field, they were able to address for the first time severe asthma management in children.

Bush and Saglani were able to deduct that a lack of proper adherence of the very basics in therapeutic treatment were to blame for masking treatable asthma as being treatment resistant. These simple techniques include, but do not exclude: inhaler technique, dose and frequency, reduction of exposure to known allergens and smoke. To reiterate, conclusions tell that less than half of the youth referred to specialist care with problematic severe asthma have true therapy-resistant asthma.

Despite the interest in innovative approaches, getting the basics right in children with apparently severe asthma will remain the foundation of management in the foreseeable future.

The formers of the study do make it a point to emphasize a mix of conventional and scientifically advanced treatments are imperative to prevent wrong diagnosis and step up symptom management.

Bush and Saglani further outline a path for success in the treatment of severe asthma in children. To start, an in depth re-evaluation of the original diagnosis is required, and determine that all conventional means of asthma attack management are being properly adhered to. Following this step, a more detailed evaluation should take place to see if the asthma is being enhanced in conjunction with other behavioral symptoms such as irregular breathing, over eating and allergies to certain kinds of foods. Finally, it is very important to monitor if there are improvements in severe asthma symptoms when the basic management tools are corrected or if they are in fact, verifiably resistant to treatment.

Once the basic treatment parameters are aligned, the authors suggest two stages of invasive investigations to re-assess symptoms, followed by the development of an individualized treatment plan tailored to clinical symptoms and the underlying changes of normal mechanical, physical, and biochemical functions.

The study also recognizes just how complex treatments can be, especially in true therapy resistant patients. Based on personal experience, Bush and Saglani explain in detail treatment options with experimental tactics, licensed, and unlicensed drugs in their full report.

What is the future of severe asthma treatment for children? Currently advanced adult treatments are on the horizon, such as monoclonal antibody therapies that specifically bind to target cells, and then may stimulate the patient's immune system to attack those affected cells. There is also bronchial thermoplasty, a new treatment for asthma involving the delivery of controlled, therapeutic radiofrequency energy to the airway wall, thus heating the tissue and coagulating bronchial tissue, reducing the amount of smooth muscle present in the airway wall. Child testing has not been conducted for either of these treatments to date, but inevitably should be done to improve quality of life in children with cases of severe asthma.

"Management of severe asthma in children"

Prof Andrew Bush MD, Sejal Saglani MD

The Lancet, Volume 376, Issue 9743, Pages 814 - 825, 4 September 2010


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