Difficult to control asthma in children.
OBJECTIVE
The management of children with difficult asthma requires a systematic approach. These children are prescribed high doses of inhaled or oral corticosteroids and a balance must be struck between therapeutic efficacy and side effects. It is important to ensure the diagnosis is correct and that the reasons for poor control in a given child are characterized so that treatment can be targeted for maximal effect.


RESULTS
Recent data have demonstrated the correlation between invasive and noninvasive measurement of airway eosinophils. Noninvasive markers of inflammation can be used to determine phenotype and there is increasing evidence on the utility of repeated measures to monitor control and treatment effects. Side effects of high-dose corticosteroids remain a concern. The emergence of new therapies may be of benefit. These are often expensive, however, and have the potential for major side effects. Adherence remains a significant obstacle to the effective management of difficult asthma.


CONCLUSIONS
Children with difficult asthma are a heterogeneous group. Characterization and monitoring of these children can be enhanced by measurements of noninvasive markers of inflammation. Further evaluation of new and phenotype-specific treatments for children with difficult asthma need to be evaluated in prospective randomized controlled trials.
Fleming
Louise
L
Department of Paediatric Respiratory Medicine, Imperial College of Science, Technology and Medicine at the National Heart and Lung Institute, London, UK.
Wilson
Nicola
N
Bush
Andrew
A
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D004305:Dose-Response Relationship, Drug; D006801:Humans
D000305:Adrenal Cortex Hormones