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Printable Handouts
Navigable Slide Index
- Introduction
- COI statement
- Aims of the presentation
- Talk outline
- Case 1: background
- Case 1: Inpatient assessment
- Case 1: Inpatient assessment (measurements)
- Case 1: urgent call
- Case 1: summary
- Case 1: plan
- Case 2: background
- Case 2: admission
- Case 2: admission (measurements)
- Case 2: summary
- Case 2: plan
- Case 3: background
- Case 3: admission
- Case 3: admission (measurements)
- Moving on: did we have it right in 2008?
- Problematic severe asthma: 2008 definition
- 2008 terminology and definitions
- ‘DA’ does not mean asthma disappears!
- Why asthma still kills
- A new framework for thinking
- How does it work? severe asthma
- Co-morbidities
- Environment/lifestyle
- Problematic respiratory symptoms
- What's new in severe therapy resistant asthma?
- Protocol
- Example
- Are they adult ‘Th2HI’?
- No TH2 cytokines in kids!
- Do not ‘DREAM on’ (at least in kids!)
- Eosinophilia: always Th2?
- STRA patients (bronchial epithelium)
- Intra-epithelial neutrophils: BETTER outcomes!
- Neutrophils in asthma
- Is asthma an infectious disease?
- Steroid responsive?
- Paediatric steroid response?
- How do these criteria perform?
- Alarmins?
- ILCs: new data
- ILCs: more results
- Fibroblast work
- IL-33 is expressed in severe asthma
- IL-33 & Vitamin D
- Severe asthma with fungal sensitisation (SAFS)
- SAFS in children
- Increased IL-33 in BAL & endobronchial biopsies
- Refractory asthma plus
- What is ‘refractory asthma plus’?
- A swimmer who kept coming last
- Videotaping for DX VCD
- VCD: Cycling
- Underwater!
- EIB vs. VCD/EILO vs. Obesity
- What is ‘refractory asthma plus’?
- Obese: Fixed airflow obstruction, dysanapsis
- Obesity and dysanapsis
- What they found
- Obese asthma: variable airflow obstruction
- Allergic infection pollution
- Airway as victim!
- Obese asthma: infection?
- Refractory difficult asthma
- What is ‘refractory difficult asthma’?
- Refractory difficult asthma-1
- The elephant in the room
- Electronic monitoring (1)
- Electronic monitoring (2)
- Game, set and match!
- BUT! still not good enough
- Refractory difficult asthma-2
- Summary and conclusions
- Take-home messages
- More self-advertising
- Thanks for listening
Topics Covered
- Examples of representative airway diseases in children
- Updating our view about severe asthma
- Review of novel mechanistic data in true severe therapy-resistant asthma
- Different phenotypes of ‘steroid resistant asthma’ and their management
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Bush, A. (2018, January 31). Severe asthma in children [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved October 11, 2024, from https://doi.org/10.69645/RGEX4400.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Andrew Bush has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
A selection of talks on Immunology & Inflammation
Transcript
Please wait while the transcript is being prepared...
0:00
Thank you very much for listening to this talk about "Severe Asthma in Children".
I'm Professor Andrew Bush.
I'm a Professor of Pediatrics at Imperial College and
a consultant pediatric chest physician at the Royal Brompton Hospital,
and I'm presenting on behalf of our multidisciplinary team.
0:17
I have no conflict of interest with regard to this presentation.
0:23
The aims of my presentation are as follows.
I'm going to present three cases of children
representative of the sort of airway diseases referred to us.
The details have been slightly altered to preserve anonymity.
I aim to update our thinking about severe asthma from where
we were in 2008 in light of the National Review of Asthma Deaths.
I'm going to review some novel mechanistic data that we've
discovered in those with true severe therapy-resistant asthma.
And I'm going to propose three very different phenotypes of
'steroid resistant asthma' and discuss their management.
1:03
So first of all,
I'm going to talk about three children who have not read the guidelines.
1:11
This is the first case.
This is a 12 year old atopic girl.
She had asthma for the last four years, worse in the last year.
She'd been taken to Accident and Emergency by ambulance six times in the preceding month.
She had continued acute bronchodilator responsiveness
to Salbutamol demonstrated in clinic.
And we use a smart inhaler electronically monitoring her treatments,
and she activated the inhaler about 80 percent of the time that we wanted.
She was admitted for an assessment.