title: Getting the basics right resolves most cases of uncontrolled and problematic asthma.
abstract: OBJECTIVE
  The prevalence of true therapy-resistant asthma among children whose asthma remains uncontrolled, despite daily controller therapy, is unknown. The aim of this study was to investigate the underlying causes in children with uncontrolled asthma.
  
  
  METHODS
  This was a retrospective chart review of 142 children aged from five to 17 years over a five-year period. The patients had uncontrolled asthma and were referred by general practitioners to a hospital-based paediatric asthma clinic.
  
  
  RESULTS
  An underlying cause for uncontrolled asthma was found in 138 children (97.2%). The causes were poor adherence (n = 53, 37.3%), ongoing exposure to environmental triggers (n = 40, 28.2%), comorbidities (n = 28, 19.7%), incorrect inhaler technique (n = 11, 7.7%) and incorrect diagnosis (n = 6, 4.2%). After properly addressing these basics in asthma management, the asthma was well controlled in all 138 patients and lung function was normal. Only four children (2.8%) fulfilled the criteria for true therapy-resistant asthma.
  
  
  CONCLUSIONS
  A remedial cause in the basics of asthma management could be found in 97% of children with uncontrolled asthma referred to a hospital-based asthma clinic. True therapy-resistant asthma was found to be very rare in children.
authors.affiliation: Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands.
authors.forename: Eric P
authors.initials: EP
authors.lastname: de Groot
authors.affiliation: Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Kreggemeijer
authors.affiliation: Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands.|UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands.
authors.forename: Paul L P
authors.initials: PL
authors.lastname: Brand
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000009:adverse effects; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D012017:Referral and Consultation; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D000485:Allergens; D018927:Anti-Asthmatic Agents
keywords: Allergic rhinitis; Dysfunctional breathing; Inhalation technique; Paediatric asthma; Uncontrolled asthma