Management of severe asthma in children

The majority of children with asthma are classified as mild/moderate and can be successfully managed with regular inhaled corticosteroids and bronchodilators. However, more than 5% of asthmatic children continue to have sub-optimal control despite apparently appropriate therapy. These children suffer significant morbidity including poor school attendance, adverse effects on family life and consume disproportionate health care resources. True therapy resistant asthma is rare in children and paediatricians should focus on ensuring the correct diagnosis, identifying and managing modifiable risk factors for difficult to control asthma before using the label severe asthma. Management of severe asthma requires a multidisciplinary approach. Symptomatic children on Step 4 (less than 5 years) or Step 5 (more than 5 years) of British Thoracic Society/SIGN Asthma Guideline or in children with diagnostic uncertainty should be referred to the local tertiary paediatric respiratory service.