[Difficult asthma in children].
Difficult asthma in children is defined as the persistence of exacerbations or frequent symptoms requiring rescue bronchodilator, or persistent airway obstruction in spite of treatment with inhaled steroid >/= 800 microg/d beclomethasone or equivalent and beta-2 long acting agonist. Management of difficult asthma in children first requires to identify conditions that may mimic asthma, asthma with bad compliance to treatment, and difficult asthma in relation with avoidable factors that worsen symptoms. The pathological bases of genuine difficult asthma remain unknown. Different patterns have been described according to the cells that are involved (eosinophil, neutrophil), the degree of airway remodeling, or the distal localization of the lesions. Difficult asthma requires specialized management including airway inflammation evaluation. Studies on bronchoalveolar lavage and bronchial mucosa biopsies will perhaps help to better understand the pathophysiology and to improve the management.
Iliescu
C
C
Service de pneumologie et d'immunoallergologie, CHRU, Lille, France.
Tillie-Leblond
I
I
Deschildre
A
A
de Blic
J
J
D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D001706:Biopsy; D001980:Bronchi / Q000473:pathology; D018893:Bronchoalveolar Lavage; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D012720:Severity of Illness Index; D013147:Spirometry