Difficult-to-Treat Asthma Management in School-Age Children

The World Health Organization divides severe asthma into three categories: untreated severe asthma; difficult-to-treat severe asthma; and severe, therapy-resistant asthma. The apparent frequency of severe asthma in the general population of asthmatic children is probably around 5%. Upon referral of these children, it is important to evaluate the diagnosis of asthma carefully before modifying management and applying a long-term monitoring plan. Identification of pathophysiologic phenotypes using objective biomarkers is essential in our routine assessments of severe asthma. Although conventional pharmacologic approaches should be attempted first, there is growing recognition that children with difficult-to-treat asthma may have unique clinical phenotypes that may necessitate alternative treatment approaches including asthma biologics. These new medications, especially those with effects on multiple pathologic features of asthma, raise the hope that new treatment strategies could induce remission. Besides introducing new medications, the opportunity for closer monitoring is feasible with advances in digital health. Therefore, we have the opportunity to improve response to medications, individualize treatment, and monitor response along with potential steps to prevent severe asthma. (C) 2021 American Academy of Allergy, Asthma & Immunology

Automated summary

The World Health Organization categorizes severe asthma into three types and estimates the frequency of severe asthma in children. It is essential to carefully evaluate the diagnosis of asthma and utilize objective biomarkers to assess the pathophysiologic phenotypes of severe asthma. Children with difficult-to-treat asthma may require alternative treatment approaches, including asthma biologics. In addition to introducing new medications, advancements in digital health offer the opportunity for closer monitoring to improve treatment response and prevent severe asthma.