title: Children with difficult asthma: a practical approach.
abstract: Many open studies investigating the effects of innovative treatments for steroid-dependent asthma demonstrate some benefit. This is also true of the majority of placebo arms in placebo-controlled trials. This suggests that children with difficult asthma benefit from the high level of input that is typically provided in clinical trials, with or without additional medication. Such intensive management of patients, with the emphasis on establishing the diagnosis, improving adherence, and identifying provoking factors, is the key to optimizing asthma control for these children. For patients with genuinely severe asthma, despite high doses of conventional treatment, a greater understanding of the pathological basis of persistent symptoms is needed. Identification of different pathological subtypes of severe asthma should allow for more rational prescribing of asthma therapy, as well as the design of further trials of potential steroid-sparing treatments.
authors.affiliation: Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK.
authors.forename: D N
authors.initials: DN
authors.lastname: Payne
authors.forename: I M
authors.initials: IM
authors.lastname: Balfour-Lynn
mesh_terms: D000280:Administration, Inhalation; D000465:Algorithms; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology / Q000628:therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D019468:Disease Management; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020024:Leukotriene Antagonists; D013256:Steroids; D017211:Treatment Failure
chemical_list: D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D007166:Immunosuppressive Agents; D020024:Leukotriene Antagonists; D013256:Steroids