Journal Reading

SEVERE ASTHMA IN CHILDREN AND

ADOLESCENTS

Suryo Permadi
Supervisor:
dr. Ismiranti Andarini, Sp.A, M.Kes

PROGRAM PENDIDIKAN DOKTER SPESIALIS

PULMONOLOGI DAN KEDOKTERAN RESPIRASI
FK UNS/ RS Dr. MOEWARDI SURAKARTA
 Journal Analyst
Population : Children and adolescent with
severe asthma

Intervention : -

Comparison : -

Outcome : Controled asthma in children and

adolescent
 Introduction
Asthma in children and adolescents
• Asthma remain symptomatic although in ICS therapy
• Some cases requiring drug combination
• Not a clearly defined entity

Difficult asthma
• Remain sympthomatic (severe or chronic symptom)
• Show poor control under the treatment
• High demand for therapeutic intervention
• Severe or frequent exacerbations and asthma attacks
• Impaired quality of life
 SEVERE ASTHMA CRITERIA
ERS WHO

• Chronic • Untreated severe

obstructive asthma
symptoms • Difficult to treat
• High treatment asthma
level • Treatment
• Acute severe resistant severe
astma attacks asthma
CRITERIA FOR ASTHMA CONTROL

No symptoms
Normal daily
or use of rescue
activities
medication

Normal lung
function
 Treatment

Therapeutic choice
Inhalant
corticosteroid (ICS)
Combination with
LABA, LAMA,LTRA
Oral Corticosteroid
(OCS)
Biologicals
tretament
Treatment algorithm for Severe Asthma

Classify
Assure Treat and
severity
diagnosis prevent
and type
 Assure Diagnosis
Need to differentiate between geuine severe asthma
and difficult to treat asthma

Really asthma or
condition similar with Comorbities?
asthma?
Questions
Adherence? Treatment?
Classify severity and type
Measure

Level of lung function

Level of controls
Level of treatment
Level of instability
Level and type
inflammation
 Treat and prevent

Controlled asthma
• Remain at current level treatment
• Control at regular intervals

Uncontrolled asthma
• Step-up therapy according guidline
Step-up therapy for severe asthma

First step
Second step
Drug combination
Try add-on LAMA Use biological according
Assess symptoms, lung function, inflamamtion profile
control after 4-6 weeks Avoid use of systemic
corticosteroids for longer period
Assess symptoms, lung function,
control after 4-6 weeks
 Priorities treatment with biologicals
sIgE againts High total IgE High FeNO High numbers
perennial serum levels levels of eosinophils
allergens in PB

Consider 1 2 3 4
anti-IgE
Consider 4 3 2 1
anti Il-5

Priorities : 1 is highest , 4 is lowest

 Conclusions

It is important to establish diagnosis of severe asthma

Treatment algorithm for severe asthma in children and adolescents

are assure diagnosis, classify severity and type, treat and prevent

Step-up therapy is need for uncontrolled patients

Biologicals should be considered in allergic asthma and poor

controlled patients.
THANK YOU