Asthma phenotypes in children

Published on December 29, 2011 Archived on January 31, 2018   35 min

Other Talks in the Series: Advances in Asthma

ANDREW BUSH: Thank you for listening to this online lecture. My name's Andrew Bush. I'm professor of Pediatrics at Imperial College.
The aim of my presentation is to discuss the approach to the child with 'nightmare asthma', to demonstrate a protocol for the assessment of problematic, 'severe asthma', and review the potential phenotype-driven treatment options that we have available to us.
The basics of asthma are very straightforward. Most children with asthma are very easily treated. Most respond to modest doses of inhaled corticosteroids, and neither need, nor get no benefit from higher doses, and high dose inhaled corticosteroids may be harmful. So the question faced with a child with nightmare asthma is, what makes this child's asthma different from the run of the mill asthma and makes it difficult to treat?
We can get a clue from this study from North America, which was a study in futility. The aim of this study was to assess whether azithromycin or a leukotriene receptor antagonist was a better add-on therapy for children who were still symptomatic, despite inhaled corticosteroids and inhaled long-acting bronchodilator. 292 children were assessed for eligibility, but only 55 could be randomized. The others were excluded due to nonadherence or they did not have asthma, and this underscores the fact that many children with so-called "difficult asthma," in fact, do not have any such thing.