Severe Asthma in Children: Therapeutic Considerations

Louise Selby; Sejal Saglani


Curr Opin Allergy Clin Immunol. 2019;19(2):132-140. 

In This Article


A step-wise approach to diagnosis and management of school-aged children with PSA, undertaken in specialist centres is essential. Before therapy escalation, detailed MDT assessments that allow identification and correction of reversible factors contributing to poor asthma control are needed. Recent studies suggest only 20–30% of all children with PSA have STRA, highlighting the importance of the MDT in management. The most common reversible factor is poor adherence to maintenance ICS and objective adherence monitoring must be undertaken. Detailed pathophysiological assessments of children with STRA will define phenotype, but currently, paediatric efficacy data of novel biologics (other than omalizumab) and biomarkers that identify the optimal add-on therapy for each child are lacking. If we are to progress toward effective individualized therapy for children, we urgently need pragmatic clinical trials of biologics in accurately phenotyped children.