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  Authority of Polish Society of Allergology

vol 18. no 3. September 2013  

 Review articles
Problematic severe asthma in children
Izabela Modelska-Woźniak, Marek Kulus, Joanna Lange

Problematic severe asthma is an important clinical challenge to all doctors. It is seen in about 5% of pediatric patients with asthma, but consumes over 50% of all funds spent in developed countries on asthma management in children. Proper protocol of investigation in this type of asthma consists of four steps: 1) verification of diagnosis in order to identify non-asthmatic patients, 2) assessment of factors contributing to limited therapy efficacy (e.g. wrong inhalation technic, continuous allergen exposure, psychosocial problems), 3) diagnosis of the type of airways inflammation and 4) exclusion of possible resistance to steroids.
Two first steps lead to identification of patients without asthma or with asthma complicated by concomitant diseases or with asthma difficult - to – treat. All of them can be cure with standard therapy and environmental modifications. The remaining group of patients (about 40-50% of children with “problematic severe asthma”) has severe therapy-resistant asthma and should be treated e.g. with higher doses of steroids, biological and/or experimental therapies.

keywords: astma niekontrolowana, astma trudna do leczenia, dzieci, astma oporna na leczenie, omalizumab,uncontrolled asthma, difficult-to treat asthma, children, therapy – resistant asthma, omalizumab

pages: from 130 to 139

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