Evaluation and treatment of severe bronchial asthma

Abstract

"Asthma without good control even with basic treatment in treatment step 4" was defined as refractory asthma in the Japanese pediatric guideline for the treatment and management of asthma 2017. In the management of refractory asthma, it is important to consider factors that affect control, such as a review of diagnosis and a review of adherence and inhalation techniques, and to intervene if necessary. Patients whose control does not improve after the intervention are managed as true severe asthma. The administration of biologics should be considered before introducing oral steroids as an additional treatment in children due to non-negligible side effects such as growth suppression.

Currently, three biologics are available for children: omalizumab, mepolizumab, and dupilumab. Biologics are very powerful treatment option. However, the administration of biologics is highly effective in some cases, but limited in some cases. Biomarkers useful for optimizing the treatment target and treatment method, and evaluation methods after administration is started. The evaluation methods, timing of evaluation, methods for enhancing efficacy, timing of discontinuation, and effects on long-term prognosis after the start of biologic administration are topics for further study.