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Good News for Kids with Treatment-Resistant Asthma

by The Kid's Doctor Staff

If your child has asthma, then you’re probably not surprised to learn that approximately one in every 10 kids in the U.S. has asthma. And about one in 20 has a severe form that doesn’t respond to standard therapies.But the good news is that a report in one of the world’s leading medical journals, The Lancet, states that about half of the treatment-resistant asthma in children is actually quite treatable.

After thoroughly evaluating the evidence to date, Drs. Andrew Bush and Sejal Saglani of the Imperial School of Medicine, in London, think that the true number of problematic asthma cases may be far lower than first thought.

They say a lot of children may be misdiagnosed with severe asthma, or may not be taking their medications correctly.

“These kids have a lot of problems,” Bush told Reuters Health in an email, “but nurses, working with parents, lead to around half of children being able to manage their asthma better without intensifying medicines.”

The team notes that a lack of rigorous studies specific to this young treatment-resistant group of asthmatics limits a doctor’s ability to optimally diagnose and treat them. So Bush and Saglani looked to research on mild-to-moderate cases of asthma in children and severe asthma in adults, as well as their own clinical experiences, to identify problems and develop an improved, multidisciplinary management plan.

What they discovered was that many cases of what appeared to be treatment-resistant asthma were really just the result of patients not taking their medicine correctly — either they weren’t using their inhaler properly, or they weren’t taking the right dose of medication each day.

They also found that less than half of patients picked up more than 80 percent of their prescriptions, and that many of the drugs sitting in patients’ medicine cabinets were past their expiration dates.

Another danger for children with asthma was being exposed to tobacco smoke.

Other health problems children with asthma may have, such as food allergies, breathing problems, and particularly obesity, need to be evaluated too.

“Severe asthma in early childhood predisposes them to obesity, as children get high doses of steroids and are inactive,” said Dr. Sally Wenzel, director of the University of Pittsburgh Asthma Institute who was not involved in the review.  She added that asthma could also be a potential driver of obesity in the teenage years.

The report suggests that doctors should return to the basics of re-evaluating patients to confirm they truly have asthma and to ensure that fundamental treatments are met.

Although promising new asthma treatments are currently in the works, the evidence suggests that conventional therapies, if used correctly, could work for more than half of these kids.

“If the asthma is bad,” Bush added, “get referred to a multidisciplinary pediatric respiratory team who can reassess the whole problem from the beginning.”

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