Is It the Patient or the Treatment That's Resistant?

Study: half of treatment-resistant asthma cases could be corrected using conventional therapies

(RxWiki News) Many children with severe, so-called treatment-resistant asthma have been given the wrong diagnosis or are not taking their medication correctly, according to a recent medical review.

Researchers found that the best approach to dealing with this problem involves a "thorough multidisciplinary assessment," projected to result in at least 50 percent of these children successfully managing their asthma with standard therapies.

Andrew Bush and Sejal Saglani from Imperial College London and the Royal Brompton Harefield NHS Foundation Trust, UK, reviewed published evidence on adults with severe asthma and children with mild-to-moderate asthma and incorporated data from their personal clinical practice. The studies they reviewed showed that many cases of apparently treatment-resistant asthma may stem from poorly managed steps and precautions, including adherence to treatment, inhaler technique, dose and frequency, and minimization of exposure to environmental triggers such as allergens and smoke.

Based on their findings, Bush and Saglani suggest efforts that should be taken to prevent misdiagnosis and to improve management of the disease. They recommend a multidisciplinary-filtering process to analyze whether asthma is worsened by comorbidities such as dysfunctional breathing, obesity and food allergies in addition to whether corrections of poor adherence to treatment are being addressed.

Future treatments for children, for which data is still needed, may include successful therapies in adults like monoclonal antibody therapies and bronchial thermoplasty.

"Despite the interest in innovative approaches, getting the basics right in children with apparently severe asthma will remain the foundation of management in the foreseeable future," the authors conclude.

Asthma (an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness and coughing) afflicts about 34.1 million Americans.

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Review Date: 
December 8, 2010