Severe Asthma: Challenges and Pitfalls in Management

Indian J Pediatr. 2018 Sep;85(9):763-772. doi: 10.1007/s12098-018-2686-0. Epub 2018 May 7.


A small but significant subset of asthmatic children show a lack of response to standard management, resulting in further intensification of therapy to optimise symptom control and may remain symptomatic despite maximal therapy. Severe asthma results in increased risk of adverse outcomes whilst contributing significantly to the economic burden on the nation's health resources. The ERS / ATS guidelines were published in 2014 and form the basis of identifying, evaluating and managing severe asthmatic children. However, much of this evidence is extrapolated from adult studies and may be inappropriate in children as unlike adults, children have a more atopic phenotype. Severe asthma is an umbrella term and may represent several overlapping heterogeneous wheezing entities. This chapter aims at discussing the strategies employed in managing severe asthmatic children with particular focus on diagnostic challenges and management pitfalls. Particular emphasis is put into the logical and systematic approach to a child with severe asthma and describes the multidisciplinary approach to manage these children. Finally, this chapter describes the novel therapies available in children and in adults in managing this challenging condition.

Keywords: Asthma plus; Biologic therapy; Difficult asthma; Severe asthma; Severe therapy resistant asthma.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / complications
  • Asthma / diagnosis*
  • Asthma / psychology
  • Asthma / therapy*
  • Child
  • Cost of Illness
  • Environmental Exposure / adverse effects
  • Humans
  • Medication Adherence
  • Risk Factors
  • Severity of Illness Index


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents