Severe asthma: looking beyond the amount of medication
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When severe asthma was defined using ERS/ATS or WHO criteria, only a small number of children were classified as having severe asthma, suggesting that we need to look beyond the amount of medication and disease control when defining severe disease.
“However, when “severe asthma” was defined using ERS/ATS (35) or WHO (41) criteria, only a small number of children were classified as having severe asthma, suggesting that we need to look beyond the amount of medication and disease control when defining severe disease (46).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [46]
The limitation of the use of maximum treatment is that there may be different reasons for poor asthma control among patients on maximum treatment, such as wrong diagnosis, non-adherence with medication, or therapy-resistant disease.
“The limitation of the use of “maximum treatment” is that there may be different reasons for poor asthma control among patients on “maximum treatment,” such as the wrong diagnosis (46), non-adherence with medication (50), or therapy-resistant disease (48).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [46]
Despite interventions and treatments aimed at addressing modifiable factors and comorbidities, some children with difficult asthma and Asthma plus may not improve because of continued poor adherence with medications or ongoing high exposure to allergens, in which case they should be considered as having refractory difficult asthma or refractory Asthma plus.
“However, despite interventions and treatments aimed at addressing modifiable factors and comorbidities, some children with DA and Asthma plus may not improve [e.g., because of the continued poor adherence with medications (50, 68), or ongoing high exposure to allergens (69–71)], in which case they should be considered as having refractory DA or refractory Asthma plus (46, 72).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [46]
Cites
Treatable traits: toward precision medicine of chronic airway diseases
Agustí, A. G. N., Bel, E. H., Thomas, M. D., Vogelmeier, C. F., Brusselle, G., Holgate, S. T., Humbert, M. J. C., Jones, P., Gibson, P. G., Vestbo, J., et al. (2016) · European Respiratory Journal · doi:10.1183/13993003.01359-2015 · Cited by 1,102 · see citing works
Peters, M. C., McGrath, K. W., Hawkins, G. A., Hastie, A. T., Levy, B. D., Israel, E., Phillips, B. R., Mauger, D. T., COMHAIR, S. A. A., ERZURUM, S. C., et al. (2016) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(16)30048-0 · Cited by 547 · see citing works
Pediatric severe asthma is characterized by eosinophilia and remodeling without TH2 cytokines
Bossley, C. J., Fleming, L., Gupta, A. K., Regamey, N., Frith, J., Oates, T., Tsartsali, L., Lloyd, C. M., Bush, A., & Saglani, S. (2012) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2012.01.059 · Cited by 316 · see citing works
Self-citationObesity and Airway Dysanapsis in Children with and without Asthma
Forno, E., Weiner, D. J., Mullen, J. R., Sawicki, G. S., Kurland, G., Han, Y. Y., Cloutier, M. M., CANINO, G. J., Weiss, S. T., Litonjua, A. A., et al. (2016) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201605-1039oc · Cited by 290 · see citing works
Lansoprazole for Children With Poorly Controlled Asthma: A Randomized Controlled Trial
Holbrook, J. T., Wise, R. A., Gold, B. D., Blake, K., Brown, E. D., Castro, M., Dozor, A. J., Lima, J. J., Mastronarde, J. G., Sockrider, M. M., et al. (2012) · JAMA · doi:10.1001/jama.2011.2035 · Cited by 242 · see citing works
Management of severe asthma in children
Bush, A., & Saglani, S. (2010) · The Lancet · doi:10.1016/s0140-6736(10)61054-9 · Cited by 220 · see citing works
Self-citationThe importance of nurse-led home visits in the assessment of children with problematic asthma
Bracken, M. B., Fleming, L., Hall, P., Stiphout, N. V., Bossley, C. J., Biggart, E. A., Wilson, N. M., & Bush, A. (2009) · Archives of Disease in Childhood · doi:10.1136/adc.2008.152140 · Cited by 202 · see citing works
Self-citationvan Huisstede, A., Rudolphus, A., Cabezas, M. C., Biter, L. U., van de Geijn, G. J., Taube, C., Hiemstra, P. S., Braunstahl, G., & van Schadewijk, A. M. (2015) · Thorax · doi:10.1136/thoraxjnl-2014-206712 · Cited by 192 · see citing works
Why asthma still kills: The national review of asthma deaths (NRAD)
Levy, M., Andrews, R., Buckingham, R. J., Evans, H. E. R., Francis, C., Houston, R., Lowe, D., Nasser, S. M., Paton, J. Y., Puri, N., et al. (2014) · UWE Research Repository (UWE Bristol) · Cited by 109 · see citing works
Bush, A., Fleming, L., & Saglani, S. (2017) · Respirology · doi:10.1111/resp.13085 · Cited by 106 · see citing works
Self-citationSevere childhood asthma: a common international approach?
Bush, A., Hedlin, G., Carlsen, K. C. L., et al. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61422-1 · Cited by 94 · see citing works
Self-citationBossley, C. J., Fleming, L., Ullmann, N., Gupta, A. K., Adams, A., Nagakumar, P., Bush, A., & Saglani, S. (2016) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2015.12.1347 · Cited by 70 · see citing works
Self-citationLong-term effectiveness of a staged assessment for paediatric problematic severe asthma
Sharples, J., Gupta, A. K., Fleming, L., Bossley, C. J., Bracken-King, M., Hall, P., Hayward, A., Puckey, M., Balfour-Lynn, I. M., Rosenthal, M., et al. (2012) · European Respiratory Journal · doi:10.1183/09031936.00209511 · Cited by 60 · see citing works
Self-citationSulaiman, I., Seheult, J. N., MacHale, E., Boland, F., O'Dwyer, S., Rapčan, V., D’Arcy, S., Cushen, B., Mokoka, M., Killane, I., et al. (2016) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201603-222oc · Cited by 50 · see citing works
Congenital laryngomalacia is related to exercise-induced laryngeal obstruction in adolescence
Hilland, M., Røksund, O. D., Sandvik, L., et al. (2016) · Archives of Disease in Childhood · doi:10.1136/archdischild-2015-308450 · Cited by 48 · see citing works
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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
- Authors
- Bush, A., Saglani, S., & Fleming, L.
- Affiliations
- Royal Brompton Hospital (GB)
- Corresponding author
- Bush, Andrew
- Venue
- The Lancet Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 5
- Issue
- 11
- Pages
- 844-846
- ISSN
- 2213-2600 (ISSN-L)
- OpenAlex
- W2762883190
- Cited by
- 33
- References
- 15
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 8 · 2020: 2 · 2019: 13 · 2018: 1 · 2017: 1
- FWCI
- 3.45
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- The Lancet Respiratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute for Health and Care Research (CDF-2014-07-019)
- 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 › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- severe asthma, childhood asthma, difficult-to-treat asthma, therapy-resistant asthma, asthma comorbidity, bronchoscopy, airway pathology, biologic therapy, precision medicine, eosinophilia, airway remodeling, Th2 cytokines, asthma phenotyping, specialist referral, asthma action plan
- MeSH terms
- Asthma, Child, Humans, Severity of Illness Index, Treatment Failure, Anti-Asthmatic Agents, Practice Patterns, Nurses', Symptom Assessment
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