[Round Table: Severe asthma in pediatrics: diagnosis and prognosis]

Abstract

Prevalence of asthma in children is calculated around 5-10%. In spite of this, severe asthma is not frequent in children (about 1% of asthmatic children), but its prognosis is very worrying as 90% of children with severe asthma continue with asthma in adulthood. The key question is if doctors dedicated to treatment of asthmatic children are able or not able to do something in order to modify this prognosis.

Objectives: to evaluate the role of prevention measures in the evolution of severe asthma in children.

Methods: in 1995 a prospective study was begun with the aim of evaluating the evolution of a group of children who had been diagnosed as moderate or severe persistent asthma (group A; 18 patients) and comparing it with a control group of children with infrequent episodic asthma (group B, 25 patients). On the first visit we carried out anamnesis, physical exploration, skin tests, a lung function study and we trained the patient in the use of the daily diary card documenting peak expiratory flow (PEF) and asthma symptoms. Three (G-A) or six (G-B) month controls were programmed adjusting the medication dosage. Individual immunotherapy was administered, when indicated.

Results: both groups have evolved favourably. All of the patients with severe or moderate asthma, who had done the correct prevention measures and/or immunotherapy, have been able to stop the initial treatment with inhaled glucocorticosteroids (CGS) without lung function or clinical state deterioration. On the other hand the patients with poor compliance of prevention measures continued needing inhaled CGS.

Conclusions: adequate prevention measures and/or immunotherapy can influence prognosis of asthmatic children. All of this, in the long run, could avoid or delay the remodelling process and the negative factors of an intensive pharmacotherapy.