Moving toward consensus on diagnosis and management of severe asthma in children

Abstract

Children with severe asthma continue to experience symptoms despite long-term treatment with high doses of corticosteroids. Moreover, the heterogeneous nature of asthma and the presence of several phenotypes have limited our ability to develop an optimized management strategy for these patients. Adequate management of severe asthma in children necessitates a detailed understanding of what makes asthma difficult to control, knowledge of the causal factors, review of diagnosis for accurate identification of pediatric patients with severe asthma and a precise definition of the phenotypes to be able to better target the therapy. Advancement in all these aspects is likely to improve childhood asthma treatment in the future. Although our understanding of severe pediatric asthma has grown in recent years, there remains a lack of consensus and clarity around critical aspects of this condition. This review attempts to present a harmonized view on the definition of severe asthma in the pediatric age group, identification of phenotypes and diagnosis, the inflammatory cascade, pharmacological and non-pharmacological treatment strategies, considerations for follow-up and referral to specialists, and disease prevention strategies.

Keywords:

• Severe childhood asthma
• diagnosis
• disease management
• consensus

Transparency

Declaration of funding

This work was funded by Novartis Pharma AG, Basel, Switzerland.

Author contributions: All authors were involved in the conception and design, or analysis and interpretation of the data, the drafting of the manuscript, and revising it critically for intellectual content. All authors approved the final version to be published. All authors agree to be accountable for all aspects of this work.

Declaration of financial/other relationships

D.L.L. has disclosed that she has received honoraria as a speaker or as coordinator of the safety board of clinical trials, support for investigation and/or travel grants from: AstraZeneca, Boehringer Ingelheim, MSD, Novartis, Grunenthal, Meda, Sanofi, UCB, Pfizer, TEVA, GSK, Chiesi, Amstrong, Siegfried and DBV Technologies. A.N. has disclosed that he has served on advisory boards, speaker panels, or received travel reimbursement from AstraZeneca, Boehringer-Ingelheim, Merck (Schering-Plough) and Novartis; he has conducted multicenter clinical research trials for approximately ten pharmaceutical companies; he has received research, consulting, and lecturing fees from AstraZeneca, Merck, Forest Laboratories, Novartis, Schering Plough and Menarini. O.P. has disclosed that he has received research grants from Inmunotek SL; payment for lectures from Inmunotek SL, Stallergenes, Allergy Therapeutics, AstraZeneca and Novartis, and has participated in advisory boards from Novartis and Sanofi Genzyme. P.M.P. has disclosed that he has received research, consulting and lecturing fees from Novartis, Vifor Pharma and Boehringer Ingelheim. G.C. has disclosed that he has served on advisory boards and speaker panels for AstraZeneca (Pearl Pharma) and Novartis, and has conducted multicenter clinical research trials for approximately two pharmaceutical companies.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The authors thank Praveen Kaul PhD and Rahul Lad PhD of Novartis for providing medical writing support, which was funded by Novartis Pharma AG in accordance with Good Publication Practice (GPP3) guidelines.