Bronchoscopy in severe childhood asthma: Irresponsible or irreplaceable?

Section: Discussionmentioning

confidence: 99%

Pediatric flexible bronchoscopy: A single‐center report

Ferraro

Baraldi

Stabinger

et al. 2021

“…7 For this category, a bronchoscopy with bronchoalveolar lavage can be used to determine granulocyte patterns and infectious species associated with novel phenotypic features, which can be helpful in informing pathway-specific variations of the treatment. 8,9 LMICs comprise a diverse group of countries that differ widely in their health system, income distribution, level of urbanization, number of inhabitants, linguistic and cultural background, and ethnicity. 10 The International Study of Asthma and Allergies in Childhood, an epidemiological research program aimed at investigating variations in the prevalence and severity of childhood asthma at the population level in diverse countries around the world using standardized methodology, has made it possible to establish comparisons between HICs and LMICs.…”

Section: Severe Asthma: a Major Clinical Problem Mainly In Low-to-middle Income Countriesmentioning

confidence: 99%

“…A second category, called “therapy‐resistant asthma” refers to patients with true resistance to standard asthma treatments, such as inhaled or oral corticosteroids, long‐acting B‐agonists, and leukotriene modifiers 7 . For this category, a bronchoscopy with bronchoalveolar lavage can be used to determine granulocyte patterns and infectious species associated with novel phenotypic features, which can be helpful in informing pathway‐specific variations of the treatment 8,9 …”

Section: Severe Asthma: a Major Clinical Problem Mainly In Low‐to‐middle Income Countriesmentioning

confidence: 99%

When adherence and inhalation technique matter: Difficult‐to‐control pediatric asthma in low‐ to middle‐income countries

Rodríguez‐Martínez

Sossa-Briceño

Sinha

2021

Despite relatively recent advances in our understanding of the physiopathology of asthma and the availability of highly effective controller medications, such as inhaled corticosteroids (ICS), currently many pediatric patients fail to control their asthma, especially in low-and middle-income countries (LMICs). Although some of these difficult-to-control asthmatic children have severe therapyresistant asthma, most of them experience poor asthma control due to various modifiable factors, among which poor adherence to inhaled controller therapy and inadequate inhaler technique are the most common. Although electronic monitoring devices have been considered to be essential tools in identifying patients with severe therapy-resistant asthma, their high cost and low availability have currently limited their use in clinical practice. For these reasons, clinicians might consider using validated self-reported questionnaires and the weight of inhaler canisters and as alternative and valid options for assessing adherence to inhaled controller therapy. Furthermore, clinicians might consider adopting validated instruments as an objective measurement of the adequacy of inhaler technique. Although recognizing poor adherence does not automatically lead to improved adherence, it is usually an essential first step in effectively targeting adherence behavior, especially if the reasons for low or erratic compliance are explored by means of non-judgmental doctor-patient communication. These recommendations could assist in overcoming our inability to have pediatric asthmatic patients use ICS and in avoiding escalating their controller therapy toward more expensive medications, eventually reaching the use biologics. Promoting the rational and cost-effective use of asthma controller therapy could help to optimize the limited health resources in many LMICs.

“…Januska et al address the key question of the role of bronchoscopy in pediatric asthma, which elicits strong feelings of both belief and skepticism. Bronchoscopy has been used in asthma for over 100 years, though the advent of less invasive therapies in the last 40 years has meant that bronchoscopy as an asthma treatment has become less prevalent.…”

Section: What Is the Appropriate Application Of Bronchoscopy For The mentioning

confidence: 99%

Challenges in managing difficult‐to‐treat asthma in children: Stop, look, and listen

Hoch

Kattan

Szefler

2019

It is recognized that asthma places a significant economic burden on the United States, with a total cost of $81.9 billion total costs including costs incurred by absenteeism and mortality. Severe asthma places a large burden of morbidity on children and their caregivers, including severe exacerbations, medication side effects, increased missed school days leading to impaired school performance, and lower caregiver quality of life. Therefore, we need to take a careful look at how we can make asthma care more efficient and cost effective, especially for those children with severe asthma. The 2019 American Thoracic Society symposium reported in this theme issue presented four aspects of managing severe asthma in children that merit attention including patient variables that affect severe asthma, understanding patient behaviors around medications, the appropriate use of bronchoscopy in diagnosis and management of severe asthma, and also the rational use of biologic therapy. This editorial will summarize key points in each of these reviews and prompt a more careful reading of each contribution.