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

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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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Relative corticosteroid insensitivity of alveolar macrophages in severe asthma compared with non-severe asthma
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Children and the Risk of Fractures Caused by Oral Corticosteroids
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Asthma and depressive and anxiety disorders among young persons in the community
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Comparison of pharmacokinetics and systemic effects of inhaled fluticasone propionate in patients with asthma and healthy volunteers: a randomised crossover study
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Worsening of Asthma in Children Allergic to Cats, after Indirect Exposure to Cat at School
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BackgroundInfluential
Tiotropium is noninferior to salmeterol in maintaining improved lung function in B16-Arg/Arg patients with asthma
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Sputum inflammatory phenotypes are not stable in children with asthma
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Distinguishing phenotypes of childhood wheeze and cough using latent class analysis
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Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children
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Airway glutathione homeostasis is altered in children with severe asthma: Evidence for oxidant stress
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Factors associated with asthma exacerbations during a long-term clinical trial of controller medications in children
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Severe asthma in childhood: assessed in 10 year olds in a birth cohort study
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TBX21 : A functional variant predicts improvement in asthma with the use of inhaled corticosteroids
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Long-term (5 year) safety of bronchial thermoplasty: Asthma Intervention Research (AIR) trial
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Protracted bacterial bronchitis: The last decade and the road ahead
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Two novel, severe asthma phenotypes identified during childhood using a clustering approach
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Noninvasive assessment of airway inflammation in children: induced sputum, exhaled nitric oxide, and breath condensate
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Psychopathology in Patients with Severe Asthma Is Associated with Increased Health Care Utilization
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Do Inhaled Corticosteroids Inhibit Growth in Children?
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Allergen-Specific Immunotherapy for Pediatric Asthma and Rhinoconjunctivitis: A Systematic Review
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Addition of leukotriene antagonists to therapy in chronic persistent asthma: a randomised double-blind placebo-controlled trial
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Persistent airflow limitation in adult-onset nonatopic asthma is associated with serologic evidence of Chlamydia pneumoniae infection
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Mild to moderate asthma affects lung growth in children and adolescents
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The molecular phenotype of severe asthma in children
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FCER2: A pharmacogenetic basis for severe exacerbations in children with asthma
Tantisira, K. G., Silverman, E. S., Mariani, T. J., Xu, J., Richter, B. G., Klanderman, B. J., Litonjua, A. A., Lazarus, R. M., Rosenwasser, L. J., Fuhlbrigge, A. L., et al. (2007) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2007.09.005 · Cited by 155
Gastroesophageal Reflux and Asthma in Children: A Systematic Review
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Improved Asthma Outcomes in a High-Morbidity Pediatric Population
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Omalizumab Improves Asthma-Related Quality of Life in Children With Allergic Asthma
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How accurate is the diagnosis of exercise induced asthma among Vancouver schoolchildren?
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A Comparison of the Clinical Characteristics of Children and Adults With Severe Asthma
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Spacer Devices Used with Metered-Dose Inhalers
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Evaluation of Two Different Educational Interventions for Adult Patients Consulting with an Acute Asthma Exacerbation
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Classification of childhood asthma phenotypes and long-term clinical responses to inhaled anti-inflammatory medications
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Importance of hedgehog interacting protein and other lung function genes in asthma
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Adherence to inhaled corticosteroids: An ancillary study of the Childhood Asthma Management Program clinical trial
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Azithromycin or montelukast as inhaled corticosteroid–sparing agents in moderate-to-severe childhood asthma study
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Indoor allergens in school and day care environments
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Asthma patients' inability to use a pressurised metered-dose inhaler (pMDI) correctly correlates with poor asthma control as defined by the Global Initiative for Asthma (GINA) strategy: a retrospective analysis
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Change in visual analog scale score in a pragmatic randomized cluster trial of allergic rhinitis
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Is Forced Expiratory Volume in One Second the Best Measure of Severity in Childhood Asthma?
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Genome screen for asthma and bronchial hyperresponsiveness: Interactions with passive smoke exposure
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Detrimental Effects of Environmental Tobacco Smoke in Relation to Asthma Severity
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Relationship between induced sputum eosinophils and the clinical pattern of childhood asthma
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Phenotypic predictors of long-term response to inhaled corticosteroid and leukotriene modifier therapies in pediatric asthma
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Genome-wide association study identifies TH1 pathway genes associated with lung function in asthmatic patients
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Ciclesonide improves measures of small airway involvement in asthma
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The oral corticosteroid-sparing effect of omalizumab in children with severe asthma
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Passive Smoking Impairs Histone Deacetylase-2 in Children With Severe Asthma
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Predictors of response to tiotropium versus salmeterol in asthmatic adults
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Corticosteroid responsiveness and clinical characteristics in childhood difficult asthma
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Quadrupling the Dose of Inhaled Corticosteroid to Prevent Asthma Exacerbations
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Maternal depression and parenting in relation to child internalizing symptoms and asthma disease activity.
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Predictors of remitting, periodic, and persistent childhood asthma
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Systematic Review and Meta-Analysis of Anxious and Depressive Symptoms in Caregivers of Children With Asthma
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Relationship Between Disease and Psychological Adaptation in Children in the Childhood Asthma Management Program and Their Families
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Clarithromycin reduces the severity of bronchial hyperresponsiveness in patients with asthma
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Provider Demonstration and Assessment of Child Device Technique During Pediatric Asthma Visits
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Evidence for different subgroups of difficult asthma in children
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Economic burden of impairment in children with severe or difficult-to-treat asthma
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Different definitions in childhood asthma: how dependable is the dependent variable?
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“In a recent review of large cohorts of school-age asthma children, 122 publications yielded 60 different operational definitions of asthma that greatly impacted prevalence and clinical outcome assessments(39).”
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Th2-Associated Local Reactions to the Acellular Diphtheria-Tetanus-Pertussis Vaccine in 4- to 6-Year-Old Children
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Airway inflammation in children with difficult asthma: relationships with airflow limitation and persistent symptoms
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Sputum induction in children with difficult asthma: Safety, feasibility, and inflammatory cell pattern
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Investigation of young children with severe recurrent wheeze: any clinical benefit?
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Safety of bronchial thermoplasty in patients with severe refractory asthma
Pavord, I. D., Thomson, N. C., Niven, R. M., Corris, P. A., Chung, K. F., Cox, G., Armstrong, B., Shargill, N. S., & Laviolette, M. (2013) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2013.05.002 · Cited by 98
Children with severe asthma have unique oxidative stress–associated metabolomic profiles
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Fluticasone at different doses for chronic asthma in adults and children
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Severe childhood asthma: a common international approach?
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Posttraumatic stress in adolescents with asthma and their parents
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Patient characteristics associated with improved outcomes with use of an inhaled corticosteroid in preschool children at risk for asthma
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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 › Pulmonary and Respiratory Medicine › 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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