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Management of unresponsive asthma

  • Symposium on Pulmonology
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Difficult asthma is defined as asthma that is not controlled despite treatment with <>800 ug budesonide or equivalent per day. Poor control is defined as the need for bronchodilators more than three times a week, school absence of more than five days a term, or one episode or more of wheezing each month. Common causes of poor response to treatment include; wrong diagnosis, inappropriate medications or improper inhalation technique, poor adherence to medications and co-morbidity. Steroid resistant asthma is uncommon and estimated to be 1 in 1000–10000 asthmatic patients. If there is no functional improvement to prednisolone 2 mg/kg/day for 2 weeks with adherence checked by measuring serum prednisoloneand cortisol levels, a fibreoptic bronchoscopic examination with bronchoalveolar lavage and large airway biopsy should be considered. Eosinophilic inflammation identified on the biopsy in a child who is unresponsive to prednisolone may benefit from alternative anti-inflammatory treatments such as cyclosporin. Neutrophilic infiltration in biopsy may benefitwith macrolide antibiotics, 5-lipogenase inhibitors or theophyllines.

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Authors and Affiliations

  1. Department of Pediatrics, All India Institute of Medical Sciences, 1100229, New Delhi, India

    S. K. Kabra (Additional Professor) & R. Lodha

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  1. S. K. Kabra
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  2. R. Lodha
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Correspondence to S. K. Kabra.

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Kabra, S.K., Lodha, R. Management of unresponsive asthma. Indian J Pediatr 71, 729–732 (2004). https://doi.org/10.1007/BF02730664

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