Connett, G. (2000) Paediatric evaluation of difficult asthma. European Respiratory Review, 10 (69), 40-44.
Abstract
There are no easy solutions to difficult childhood asthma, but therapeutic interventions are more likely to be successful if they are based on the results of a carefully structured process of evaluation. Accurate diagnosis can be difficult in young patients. Misunderstandings about terminology and inappropriately attributing symptoms to asthma can lead to overprescribing and unrealistic expectations. Evaluation beyond a detailed history and thorough examination should include a period of symptom monitoring, a home visit, exercise challenge and tests to identify provoking allergens. Investigations to exclude diagnoses such as gastro-oesophageal reflux, immunodeficiency, middle lobe syndrome, sinusitis and cystic fibrosis should be considered. Response to a therapeutic trial of oral steroids might usefully identify a small number of patients with steroid-resistant asthma. Increasing evidence has shown that adverse psychosocial factors affect asthma morbidity and a therapeutic approach that addresses the extent to which environmental stressors impact on asthma symptoms might be of benefit in some cases.
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