title: Clinical characteristics of children and adolescents with severe therapy-resistant asthma in Brazil.
abstract: OBJECTIVE
  To describe the clinical characteristics, lung function, radiological findings, and the inflammatory cell profile in induced sputum in children and adolescents with severe therapy-resistant asthma (STRA) treated at a referral center in southern Brazil.
  
  
  METHODS
  We retrospectively analyzed children and adolescents (3-18 years of age) with uncontrolled STRA treated with high-dose inhaled corticosteroids and long-acting β2 agonists. We prospectively collected data on disease control, lung function, skin test reactivity to allergens, the inflammatory cell profile in induced sputum, chest CT findings, and esophageal pH monitoring results.
  
  
  RESULTS
  We analyzed 21 patients (mean age, 9.2 ± 2.98 years). Of those, 18 (86%) were atopic. Most had uncontrolled asthma and near-normal baseline lung function. In 4 and 7, induced sputum was found to be eosinophilic and neutrophilic, respectively; the inflammatory cell profile in induced sputum having changed in 67% of those in whom induced sputum analysis was repeated. Of the 8 patients receiving treatment with omalizumab (an anti-IgE antibody), 7 (87.5%) showed significant improvement in quality of life, as well as significant reductions in the numbers of exacerbations and hospitalizations.
  
  
  CONCLUSIONS
  Children with STRA present with near-normal lung function and a variable airway inflammatory pattern during clinical follow-up, showing a significant clinical response to omalizumab. In children, STRA differs from that seen in adults, further studies being required in order to gain a better understanding of the disease mechanisms.
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Andrea Mendonça
authors.initials: AM
authors.lastname: Rodrigues
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Cristian
authors.initials: C
authors.lastname: Roncada
authors.affiliation: Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Giovana
authors.initials: G
authors.lastname: Santos
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Heinzmann-Filho
authors.affiliation: Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Rodrigo Godinho
authors.initials: RG
authors.lastname: de Souza
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Mauro Henrique Moraes
authors.initials: MH
authors.lastname: Vargas
authors.affiliation: Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Leonardo Araújo
authors.initials: LA
authors.lastname: Pinto
authors.affiliation: Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Marcus Herbert
authors.initials: MH
authors.lastname: Jones
authors.affiliation: Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Renato Tetelbom
authors.initials: RT
authors.lastname: Stein
authors.affiliation: Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Paulo Márcio
authors.initials: PM
authors.lastname: Pitrez
mesh_terms: D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D050782:Esophageal pH Monitoring; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000188:drug therapy; D007249:Inflammation / Q000175:diagnosis; D008297:Male; D000069444:Omalizumab / Q000627:therapeutic use; D011788:Quality of Life; D011859:Radiography; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012882:Skin Tests; D013183:Sputum / Q000166:cytology; D017211:Treatment Failure
chemical_list: D018927:Anti-Asthmatic Agents; D000069444:Omalizumab