期刊
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
卷 2, 期 5, 页码 489-500出版社
ELSEVIER
DOI: 10.1016/j.jaip.2014.06.022
关键词
Childhood severe asthma; Childhood difficult-to-treat asthma; Severe asthma phenotypes; Childhood severe asthma treatment; Review
资金
- Teva
- GlaxoSmithKline
- Regeneron Pharmaceuticals
- Centers for Disease Control
- Department of Health and Human Services [DHHS FAB 20166, T72 MC00008-20-00]
- National Institutes of Health (NIH)
- University of Wisconsin Madison Medical and Education Research Committee
- GlaxoSmithKline/Development Limited
- CF Foundation Therapeutics
- Roche/Genentech
- NIH
- Aerocrine
- Genentech/Novartis
- Merck
- Schering
- Cephalon
- DBV Technologies
- National Heart, Lung, and Blood Institute (NHLBI)/NIH AsthmaNet [NHLBI U10 HL098090, U10 HL109168, P01 HL070831]
- AstraZeneca
- National Institutes of Health
- NHLBI [R01 NR012021]
- National Institute of Nursing Research [R01 NR013700]
- MedImmune
- Merck Scientific Advisory Board
- GlaxoSmithKline Advisory Board
- Genentech
- Boehringer Ingelheim
Severe asthma in children is characterized by sustained symptoms despite treatment with high doses of inhaled corticosteroids or oral corticosteroids. Children with severe asthma may fall into 2 categories, difficult-to-treat asthma or severe therapy-resistant asthma. Difficult-to-treat asthma is defined as poor control due to an incorrect diagnosis or comorbidities, or poor adherence due to adverse psychological or environmental factors. In contrast, treatment resistant is defined as difficult asthma despite management of these factors. It is increasingly recognized that severe asthma is a highly heterogeneous disorder associated with a number of clinical and inflammatory phenotypes that have been described in children with severe asthma. Guideline-based drug therapy of severe childhood asthma is based primarily on extrapolated data from adult studies. The recommendation is that children with severe asthma be treated with higher-dose inhaled or oral corticosteroids combined with long-acting beta-agonists and other add-on therapies, such as antileukotrienes and methylxanthines. It is important to identify and address the influences that make asthma difficult to control, including reviewing the diagnosis and removing causal or aggravating factors. Better definition of the phenotypes and better targeting of therapy based upon individual patient phenotypes is likely to improve asthma treatment in the future. (C) 2014 American Academy of Allergy, Asthma & Immunology
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