Severe Asthma in Pediatrics

Abstract

Asthma is a heterogeneous and complex disease, with different phenotypes and endotypes, characterized by chronic inflammation of the airways, the main ones being wheezing, cough, dyspnea, and chest oppression, with variable expiratory airflow. Severe asthma is considered a subtype of asthma that is difficult to treat, with an estimated prevalence of around 3% in pediatrics, varying according to each population studied. Diagnosis is mainly based on clinical and functional assessment. In addition to spirometry, measurement of peak expiratory flow can also be useful in diagnosis and follow-up, as can levels of exhaled fraction of nitric oxide and blood eosinophil count. In the investigation of a patient with asthma, the role of skin tests for aeroallergens or the measurement of total and specific IgE can be evaluated, as well as the performance of a bronchial provocation test with methacholine or by means of exercise. The treatment aims to achieve control of the disease. Personalized patient management is a concept considered fundamental, including a continuous cycle of evaluation, treatment adjustment, and review. The most recommended medications for the treatment of asthma are inhaled corticosteroids, which, at low doses, provide most of the clinical benefits for most asthma patients. They may or may not be associated with the long-acting bronchodilator, and anticholinergics, leukotriene receptor antagonists, or immunobiologicals may be added, depending on the stage of treatment in which the patient is. Special attention should be given to the care of modifiable factors, and the prevention of future risks is an important factor to be considered.