title: [Consensus-based approach for severe paediatric asthma in routine clinical practice].
abstract: BACKGROUND
  Accurate identification of paediatric patients with severe asthma is essential for an adequate management of the disease. However, criteria for defining severe asthma and recommendations for control vary among different guidelines.
  
  
  METHODS
  An online survey was conducted to explore expert opinions about the definition and management of severe paediatric asthma. To reach a consensus agreement, a modified Delphi technique was used, and practice guidelines were prepared after the analysis of the results.
  
  
  RESULTS
  Eleven paediatric chest disease physicians and allergy specialists with wide expertise in severe asthma responded to the survey. Consensus was reached in 50 out of 65 questions (76.92%). It was considered that a patient has severe asthma if during the previous year they have required 2 or more cycles of oral steroids, required daily treatment with medium doses of inhaled corticosteroids (with other controller medication) or high doses (with or without other controller medication), did not respond to optimised conventional treatment, or if the disease threatened the life of the patient or seriously impairs their quality of life. The definition of severe asthma may also include patients who justifiably use health resources on a regular basis, or have psychosocial or environmental factors impeding control. For monitoring, the use of questionnaires designed specifically for paediatric population, such as CAN or ACT, is recommended. As regards treatment, the use of omalizumab should be considered prior to the use of oral corticosteroids.
  
  
  CONCLUSIONS
  This paper provides consensus recommendations that may be useful in the management of severe paediatric asthma.
authors.affiliation: Alergología Infantil, Hospital Sant Joan de Deu, Barcelona, España.
authors.forename: A M
authors.initials: AM
authors.lastname: Plaza
authors.affiliation: Alergología Infantil, Hospital Niño Jesús, Madrid, España.
authors.forename: M D P
authors.initials: MD
authors.lastname: Ibáñez
authors.affiliation: Neumología Infantil, Hospital Virgen de la Arrixaca, Murcia, España.
authors.forename: M
authors.initials: M
authors.lastname: Sánchez-Solís
authors.affiliation: Unidad de Alergia, Neumología e Inmunología Pediátrica, Hospital de Sabadell, Corporación Universitaria Parc Taulí, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Bosque-García
authors.affiliation: Neumología Infantil, Hospital Marqués de Valdecilla, , Santander, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Cabero
authors.affiliation: Sección de Alergia Infantil, HMI, Málaga, España.
authors.forename: J L
authors.initials: JL
authors.lastname: Corzo
authors.affiliation: Neumología y Alergia Pediátricas, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: G
authors.initials: G
authors.lastname: García-Hernández
authors.affiliation: Alergología Infantil, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: B
authors.initials: B
authors.lastname: de la Hoz
authors.affiliation: Neumología Infantil, Hospital Universitario Donostia, San Sebastián, España.
authors.forename: J
authors.initials: J
authors.lastname: Korta-Murua
authors.affiliation: Alergología Infantil, Hospital de Puerto Real, Cádiz, España.
authors.forename: C
authors.initials: C
authors.lastname: Sánchez-Salguero
authors.affiliation: Unidad de Alergia y Neumología Pediátricas, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: J
authors.initials: J
authors.lastname: Torres-Borrego
authors.affiliation: Neumología y Alergología Infantil, Hospital Universitario Dr. Peset, Valencia, España.
authors.forename: M
authors.initials: M
authors.lastname: Tortajada-Girbés
authors.affiliation: Neumología Infantil, Hospital Universitario Los Arcos del Mar Menor, San Javier (Murcia), España.
authors.forename: J
authors.initials: J
authors.lastname: Valverde-Molina
authors.affiliation: Alergología Infantil, Hospital Materno Infantil Gregorio Marañón, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Zapatero
authors.affiliation: Neumología y Alergología Infantil, Hospital La Fe, Valencia, España. Electronic address: nieto_ant@gva.es.
authors.forename: A
authors.initials: A
authors.lastname: Nieto
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D032921:Consensus; D006801:Humans; D017410:Practice Guidelines as Topic; D011788:Quality of Life
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
keywords: Asma; Asma grave; Asthma; Delphi technique; Omalizumab; Paediatrics; Pediatría; Severe asthma; Técnica Delphi