Severe asthma in children

Guilbert, Theresa W.; Bacharier, Leonard B.; Fitzpatrick, Anne M.

doi:10.1016/j.jaip.2014.06.022

Cited by 216Asthma and respiratory diseasesOccupational exposure and asthmaAllergic Rhinitis and Sensitization

Severe asthma in children

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Guilbert, Theresa W., Bacharier, Leonard B., Fitzpatrick, Anne M.·2014·The Journal of Allergy and Clinical Immunology In Practice

DOI 10.1016/j.jaip.2014.06.022PMC PMC4589165

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Abstract

Severe asthma in children is characterized by sustained symptoms despite treatment with high doses of inhaled corticosteroids or oral corticosteroids. Children with severe asthma may fall into 2 categories, difficult-to-treat asthma or severe therapy-resistant asthma. Difficult-to-treat asthma is defined as poor control due to an incorrect diagnosis or comorbidities, or poor adherence due to adverse psychological or environmental factors. In contrast, treatment resistant is defined as difficult asthma despite management of these factors. It is increasingly recognized that severe asthma is a highly heterogeneous disorder associated with a number of clinical and inflammatory phenotypes that have been described in children with severe asthma. Guideline-based drug therapy of severe childhood asthma is based primarily on extrapolated data from adult studies. The recommendation is that children with severe asthma be treated with higher-dose inhaled or oral corticosteroids combined with long-acting β-agonists and other add-on therapies, such as antileukotrienes and methylxanthines. It is important to identify and address the influences that make asthma difficult to control, including reviewing the diagnosis and removing causal or aggravating factors. Better definition of the phenotypes and better targeting of therapy based upon individual patient phenotypes is likely to improve asthma treatment in the future.

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Severe asthma in children is much more variable with rapidly evolving severe attacks, often remaining symptom-free between attacks.
“Severe asthma is predominantly persistent in adults, but much more variable with rapidly evolving severe attacks in children, often remaining symptom-free between the attacks (75, 76).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [75]
Severe asthma is predominantly persistent in adults.
“Severe asthma is predominantly persistent in adults, but much more variable with rapidly evolving severe attacks in children, often remaining symptom-free between the attacks (75, 76).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [75]

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Epidemiology of Asthma in Children and Adults
Dharmage, S. C., Perret, J. L., & Custovic, A. (2019) · Frontiers in Pediatrics · doi:10.3389/fped.2019.00246 · Cited by 1,200 · see citing works
Severe asthma in children
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Authors: Guilbert, T. W., Bacharier, L. B., & Fitzpatrick, A. M.
Affiliations: Cincinnati Children's Hospital Medical Center (US)
St. Louis Children's Hospital (US)
Emory University (US)
Corresponding author: Guilbert, Theresa W.
ORCID: Guilbert, Theresa W.
Bacharier, Leonard B.
Fitzpatrick, Anne M.
Venue: The Journal of Allergy and Clinical Immunology In Practice
Publisher: Elsevier BV
Published: 2014-09
Volume: 2
Issue: 5
Pages: 489-500
ISSN: 2213-2198 (ISSN-L)
DOI: 10.1016/j.jaip.2014.06.022
PMC: PMC4589165
OpenAlex: W2041272141
Cited by: 216
References: 241
Citations by year: 2026: 6 · 2025: 11 · 2024: 22 · 2023: 21 · 2022: 22 · 2021: 17 · 2020: 35 · 2019: 32 · 2018: 21 · 2017: 12 · 2016: 8 · 2015: 8
FWCI: 1.09
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The Journal of Allergy and Clinical Immunology In Practice (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: U.S. Department of Health and Human Services
Cystic Fibrosis Foundation
American Academy of Allergy Asthma and Immunology
AstraZeneca
GlaxoSmithKline
Teva Pharmaceutical Industries
Regeneron Pharmaceuticals
National Institutes of Health (HL098090)
Centers for Disease Control and Prevention
Genentech
U.S. Public Health Service (NHLBI U10 HL098090, T72 MC00008-20-00, DHHS FAB 20166)
National Heart, Lung, and Blood Institute (HL098090, U10HL109168, HL109168, U10HL098090, P01HL070831)
National Institute of Nursing Research (R01NR012021, R01NR013700)
Topics: Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
Keywords: severe asthma, childhood asthma, asthma phenotypes, asthma heterogeneity, clustering, asthma control, comorbidities, medication adherence, asthma action plan, asthma education, multidisciplinary care
MeSH terms: Adolescent, Adrenal Cortex Hormones, Adult, Asthma, Child, Child, Preschool, Diagnosis, Differential, Humans, Life Style, Patient Education as Topic, Respiratory Function Tests, Anti-Asthmatic Agents

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