Challenges in uncontrolled asthma in pediatrics: important considerations for the clinician

ABSTRACT

Introduction

Despite symptoms control being the primary focus of asthma management according to guidelines, uncontrolled asthma is still an issue worldwide, leading to huge costs and asthma deaths at all ages. In childhood, poor asthma control can be even more harmful, as it can irreversibly compromise the children’s lung function and the whole family’s well-being.

Areas covered

Given the problem extent, this review aims to discuss the leading modifiable causes of uncontrolled asthma in Pediatrics, giving some practical insights regarding the critical role of families and the main tools for monitoring control and drug adherence, even at a distance. The most recent GINA documents were used as the primary reference, along with the latest evidence regarding the management of asthma control and the impact of the COVID-19 pandemic on asthma.

Expert opinion

In managing pediatric asthma, a multidisciplinary, multi-determinant, personalized approach is needed, actively involving families, schools, and other specialists. In addition to current strategies for implementing control, electronic health strategies, new validated asthma control tools, and the identification of novel inflammatory biomarkers could lead to increasingly tailored therapies with greater effectiveness in reaching asthma control.

KEYWORDS:

• Pediatrics
• difficult-to-treat asthma
• asthma control
• comorbidities
• adherence
• lung function tests
• asthma and SARS-CoV-2 pandemic
• telehealth

Article highlights

• Uncontrolled asthma is still a worldwide, costly, serious issue among children and adolescents.

• Management of asthma should be control-based, multidisciplinary and multi-determinant.

• Providers should investigate and treat all modifiable causes of uncontrolled asthma, approaching the patient, the families, and the social contest.

• Future strategies for asthma management may include novel validated control tools, improved understanding of asthma endotypes, and new electronic health strategies.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.