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Managing problematic severe asthma: beyond the guidelines

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Title: Managing problematic severe asthma: beyond the guidelines
Authors: Pike, KC
Levy, ML
Moreiras, J
Fleming, L
Item Type: Journal Article
Abstract: This review discusses issues related to managing problematic severe asthma in children and young people. A small minority of children have genuinely severe asthma symptoms which are difficult to control. Children with genuinely severe asthma need investigations and treatments beyond those described within conventional guidelines. However, the majority of children with poor symptom control despite high-intensity treatment achieve improvement in their asthma control once attention has been paid to the basics of asthma management. Basic asthma management requires optimisation of inhaler technique and treatment adherence, avoidance of environmental triggers and self-management education. It is also important that clinicians recognise risk factors that predispose patients to asthma exacerbations and potentially life-threatening attacks. These correctable issues need to be tackled in partnership with children and young people and their families. This requires a coordinated approach between professionals across healthcare settings. Establishing appropriate infrastructure for coordinated asthma care benefits not only those with problematic severe asthma, but also the wider asthma population as similar correctable issues exist for children with asthma of all severities. Investigation and management of genuine severe asthma requires specialist multidisciplinary expertise and a systematic approach to characterising patients' asthma phenotypes and delivering individualised care. While inhaled corticosteroids continue to play a leading role in asthma therapy, new treatments on the horizon might further support phenotype-specific therapy.
Issue Date: 13-Sep-2017
Date of Acceptance: 19-Aug-2017
URI: http://hdl.handle.net/10044/1/55135
DOI: https://dx.doi.org/10.1136/archdischild-2016-311368
ISSN: 1468-2044
Publisher: BMJ Publishing Group
Start Page: 392
End Page: 397
Journal / Book Title: Archives of Disease in Childhood
Volume: 103
Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Keywords: Science & Technology
Life Sciences & Biomedicine
Pediatrics
MEDICATION ADHERENCE
INHALED CORTICOSTEROIDS
MONITORING ADHERENCE
CHILDHOOD ASTHMA
CHRONIC ILLNESS
AIR-FLOW
CHILDREN
ADOLESCENTS
THEOPHYLLINE
THERAPY
Asthma
Management
Severe Asthma
1103 Clinical Sciences
1114 Paediatrics And Reproductive Medicine
1117 Public Health And Health Services
Publication Status: Published
Appears in Collections:National Heart and Lung Institute