Difficult to Treat Asthma in Children
Asthma is one of the most common chronic respiratory conditions affecting children. Most children with asthma improve with the usual treatment. Difficult to treat asthma in children refers to cases where asthma symptoms remain persistent or worsen despite standard treatment protocols including inhaled corticosteroids, long acting beta agonists and montelukast.
Children with difficult to treat asthma may experience frequent exacerbations, persistent symptoms, but limited response to medications, making their asthma more complex to manage.
This form of asthma requires a more specialized care from a pediatric pulmonologist to better manage their condition.
Key Factors Contributing to Difficult to Treat Asthma
Several factors can contribute to difficult to treat asthma in children. These include:
- Incorrect Diagnosis: Sometimes, asthma-like symptoms are caused by conditions that mimic asthma, such as gastroesophageal reflux disease (GERD), bronchiectasis, cystic fibrosis, primary ciliary dyskinesia etc. Identifying the correct underlying issue is critical to managing symptoms effectively.
- Non-Adherence to Treatment: Children may have difficulty adhering to treatment plans, especially when symptoms seem to improve or when medication routines are difficult to follow.
- Poor inhalational technique: Many children have a poor inhaler/spacer technique leading to inadequate medicine reaching the airways.
- Co-morbid or Coexisting Conditions: Children with asthma may have other medical conditions that add to asthma symptoms and require proper management. Common coexisting conditions includes nasal allergies, obesity, sinus infections or sleep apnea.
- Environmental Triggers: Environmental factors such as air pollution, dust mites, mold, pet dander, or tobacco smoke can aggravate asthma symptoms and make treatment less effective.
Severe Asthma Phenotypes
Some children have true severe forms of asthma. These children do not improve with conventional treatment and may require different treatment strategies. Severe asthma phenotypes in children could be eosinophilic asthma (characterized by high levels of eosinophils, a type of white blood cell) or neutrophilic, mixed or pauci-cellular.
Comprehensive Evaluation of Difficult to Treat Asthma
If your child has difficult to treat asthma, the first step is a comprehensive evaluation to determine the root cause of their persistent symptoms. A variety of diagnostic tools are used to thoroughly assess asthma and rule out alternative diagnoses.
- Detailed Medical History: A careful review of your child’s medical history is essential to identify factors like past treatments, triggers, and comorbid conditions that could impact asthma control. Assessment of inhaler/spacer technique is an important part of clinical assessment.
- Pulmonary Function Tests: These tests measure lung function and help determine severity of asthma and its response to treatment. Spirometry and impulse oscillometry are very useful in this regard.
- Exhaled Nitric Oxide Testing: This test helps evaluate inflammation in the airways and is particularly useful in diagnosing eosinophilic asthma, a type of severe asthma often found in children.
- Allergy Testing: Allergens can play a significant role in asthma causation and exacerbations. Identifying specific allergens that may be triggering your child’s asthma can help in crafting a more personalized treatment plan. Either a skin prick test or an ImmunoCap can be done for assessment of allergies. Allergy testing results helps to guide allergen prevention and immunotherapy in children with difficult to treat asthma.
- Chest X-rays or CT Scans: These imaging studies can rule out other lung conditions, such as bronchiectasis, structural abnormalities, or foreign objects that may be contributing to respiratory symptoms.
- Bronchoscopy: In some cases, a bronchoscopy (a procedure where a small camera is inserted into the airways) may be performed to assess the condition of the airways and gather bronchoalveolar lavage samples for further testing.
Treatment Options for Difficult to Treat Asthma
Once a comprehensive evaluation has been completed and the diagnosis is confirmed, the next step is implementing an individualized treatment plan tailored to your child’s needs. Several advanced treatment options may be considered for difficult to treat asthma:
Initial steps involve optimizing the inhaler-spacer technique and improving compliance to medicines. Add-on medicines like tiotropium can be added as inhaler for a better relief if not already given.
Some children might require newer biological medicines like Omalizumab or Mepolizumab.
- Optimizing Inhaler Spacer technique: This is a very important step in asthma treatment and often neglected.
- Addressing Asthma Triggers:Addressing environmental triggers (such as dust mites, pet dander, and smoke) can help manage symptoms more effectively.
- Treatment of coexisting or comorbid conditions: Proper treatment for associated nasal allergy, sinusitis, GERD or obstructive sleep apnea is very helpful.
- Additional Medicines: in some children additional add-on medicines as used like Inhaled Long-Acting Beta Agonists (LABAs), montelukast and tiotropium.
- Asthma Action Plans: Creating an asthma action plan tailored to your child’s needs is crucial for managing daily symptoms and responding to asthma attacks.
- Biologic Therapy: Biologic medications, such as omalizumab, mepolizumab and bendralizumab, target specific parts of the immune system involved in asthma inflammation. These treatments are particularly effective for children with eosinophilic asthma or other severe asthma phenotypes.
Difficult to treat asthma in children can be challenging, but with the right approach, it’s possible to significantly improve your child’s quality of life. A comprehensive, individualized treatment plan for children struggling with asthma is required to ensure they receive the best care possible. If your child’s asthma is not responding well to treatment consult a pediatric pulmonologist for a thorough evaluation.
Conclusion
Frequently Asked Questions (FAQs)
1. What is the difference between regular asthma and difficult to treat asthma?
Difficult to treat asthma refers to asthma that persists or worsens despite standard treatment protocols. It may be due to an incorrect diagnosis, comorbid conditions, or specific asthma subtypes that require more advanced therapies.
2. How do I know if my child has difficult to treat asthma?
If your child’s asthma symptoms are not improving with standard medications, they may be experiencing difficult to treat asthma. A pediatric pulmonologist can conduct a thorough evaluation to identify the cause.
3. Can environmental factors make asthma harder to treat?
Asthma in children often presents with more frequent respiratory infections, Yes, environmental triggers like allergens, pollution, and tobacco smoke can exacerbate asthma and make it more challenging to treat. Identifying and managing these triggers is a key part of treatment.and symptoms may vary as they grow. Children may also outgrow certain triggers over time.
4. Is biologic therapy safe for children with asthma?
Biologic therapies are generally considered safe for children with severe asthma, but they should only be prescribed by a specialist after careful evaluation. These medications target specific parts of the immune system and can significantly improve asthma control.
5. What steps can I take to help my child manage their asthma better?
Ensure your child follows their prescribed medication regimen, avoid environmental triggers, maintain regular follow-up visits with a pediatric pulmonologist, and work together to create an asthma action plan.
