Difficult asthma in the pre-school child.
The most important aspect of dealing with a pre-school child suspected of having difficult asthma, is to ensure that the diagnosis is correct, in order to avoid the inappropriate use of therapies such as inhaled corticosteroids. After exclusion of other diagnoses, if a pre-school child is thought to have asthma, difficult or otherwise, the corollary is, what sort of asthma? Is it a syndrome with airway inflammation susceptible to treatment, or one in which there is no inflammation and time alone will result in resolution of symptoms? Probably the most common mistake in this age group is to fail to recognise the latter and institute ever more aggressive and useless therapies. An approach to excluding other diagnoses, appropriate investigations to elicit the presence of airway inflammation and suggestions for subsequent management have been detailed in this review.
Department of Respiratory Paediatrics, Royal Brompton Hospital, Sydney Street, London, UK.
Sejal
S
Saglani
Warren
W
Lenney
D000367:Age Factors; D001249:Asthma / Q000175:diagnosis* / Q000628:therapy; D002675:Child, Preschool; D003948:Diagnostic Techniques, Respiratory System; D006801:Humans