oa Current Allergy & Clinical Immunology - Difficult-to-control asthma in children - an overview : review article

Volume 24, Issue 1
  • ISSN : 1609-3607



Difficult-to-control asthma is asthma which is inadequately controlled despite appropriate therapy, adjusted for clinical severity of the asthma. There are many terminologies used, interchangeably, to describe this condition. Difficult-to-control asthma may be divided into 'false' difficult-to-control and 'true' difficult-to-control asthma; the latter has major and minor criteria that must be met to diagnose it appropriately. To diagnose true difficult-to-control asthma, the clinician must rule out conditions that mimic asthma as well as co-morbid conditions.

To make a diagnosis, it is necessary to take a good clinical history, perform a careful examination of the patient and investigate the patient appropriately. These steps will help to rule out conditions that are often wrongly diagnosed and treated as asthma.
Management consists of environmental control, psychosocial therapy and treating comorbid conditions.
Pharmacological therapy is challenging. It may require manipulation of dosages of inhaled corticosteroids, oral (or occasionally intramuscular) corticosteroids, long-acting β-agonists, leukotriene antagonists, omalizumab and, as a last resort, immunosuppressant therapy.

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