Difficult asthma and its treatment in pediatrics
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Difficult asthma which constitutes less than 5% of all childhood asthma cases is defined as presence of daily symptoms, frequent oral corticosteroid requirement and frequent exacerbations for longer than six months, despite the use of inhaled steroid equivalent to 500 mcg fluticasone propionate, long acting beta 2 agonist or theophylline and leukotriene antagonists. Difficult asthma is not expected in childhood due to the absence of remodelling, rapid restoration of the airway, use of efficacious inhaled techniques and steroids and absence of occupational exposures. Therefore, it may be thought that pediatric difficult asthma is a differential diagnosis and treatment adherence problem. It has been shown that difficult asthma cases that have been filtered from this aspect have a non-eosinophilic inflammatory phenotype characterized by defective beta 2 receptor responses and high steroid resistance. Increased thickness of the basal membrane supports the view that dysfunctional mechanisms play a more important role than inflammatory mechanisms. Environmental control and elimination of risk factors should be achieved in these cases and proper education for treatment modalities and inhalation techniques need to be provided. (Turk Arch Ped 2010; 45: 80(th) Year: 1-5)