'Difficult asthma': can symptoms be controlled in a structured environment?
OBJECTIVE
Difficult asthma implies persistent asthma symptoms despite therapy with high doses of inhaled corticosteroids. The objective was to evaluate children with difficult asthma in a setting that excludes aggravating factors such as poor treatment adherence and adverse environmental influences.


METHODS
Sixty children (> or =6 years) had been referred because of difficult asthma to the rehabilitation centre over a period of 10 years. The diagnosis of poor asthma symptom control was confirmed if exacerbations continued during stay in the centre or if symptoms interfered with daily activities at least 3 times a week.


RESULTS
The median stay at the centre was 5 months. In four patients a diagnosis other than asthma was made. In five patients symptom control remained difficult. In the remaining 51 children, asthma symptoms became well controlled. Many factors contributed to poor asthma control in the home setting: poor treatment adherence (n = 32), parental smoking (n = 22), allergen exposure (n = 10). Psychosocial problems occurred in 36 children. Contributing factors often co-existed. During stay at the centre, lung function improved in the group with well controlled asthma symptoms (P < 0.001) but not in the group with continued poor symptom control. In the majority of children who obtained good symptom control, this persisted in the years following discharge.


CONCLUSIONS
Of 60 children referred with a diagnosis of difficult asthma, optimal medical management in a structured environment resulted in good symptom control in 51 patients; symptom control remained poor in 5 patients, a diagnosis other than asthma was made in 4 patients.
De Boeck
K
K
University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium. christiane.deboeck@uzleuven.be
Moens
M
M
Van Der Aa
N
N
Meersman
A
A
Schuddinck
L
L
Proesmans
M
M
D000293:Adolescent; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence; D012047:Rehabilitation Centers; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D014028:Tobacco Smoke Pollution; D055815:Young Adult
D014028:Tobacco Smoke Pollution