Asthme difficile de l'enfant : un diagnostic moins invasif ?

Difficult asthma in children is a heterogeneous disease characterized by persistence of symptoms and/or pulmonary function deterioration despite optimal treatment. Evaluation of patients with difficult asthma aims to exclude alternative diagnoses, poor compliance, consideration of aggravating factors and finally, investigation of inflammation and airway remodelling. In addition to leading to better understanding of the pathophysiology and natural history of asthma, the results of these investigations will help in the future management of children with difficult asthma. To date, bronchoalveolar lavage and endobronchial biopsy are the most well validated techniques for such evaluation, but non-invasive techniques such as exhaled NO, induced sputum, breath condensate, and perhaps CT scan need to be evaluated in children with difficult asthma.