AN UPDATE ON PAEDIATRIC SEVERE ASTHMA

Children with severe asthma have recurrent exacerbations and/or persistent symptoms despite maximal treatment with conventional medication. Severe asthma in childhood is particularly difficult to treat, with substantial morbidity. There are few randomised controlled trials in these patients; evidence therefore has to be extrapolated from adult studies or paediatric studies of mild to moderate disease. The first step is often a detailed diagnostic evaluation. Patients with severe asthma can then be further categorised as one of: wrong diagnosis; significant comorbidity; difficult-to-treat; and true, therapy-resistant asthma. There are very few licensed treatments for this challenging group of children including high-dose inhaled steroids, SMART regimen and anti-IgE therapy. Many of the other treatments used (e.g. methotrexate, ciclosporin) are unlicensed. It is important, therefore, to ensure that the basics are right. Adherence must be optimised, comorbidities treated, inhaler technique regularly checked and allergen load reduced to a minimum.