Treatment-resistant asthma: options and decision making

Asthma represents one of the most common chronic conditions affecting children. Effective therapies exist, but some children continue to have treatment-resistant asthma. Management remains a significant challenge and evidence for the treatment of asthma at the severe end of the spectrum is lacking. However, a structured approach to assessment and management can be used to improve patient outcomes. For the minority in whom symptoms persist, further investigations, alternative anti-inflammatory drugs or more novel therapies, such as anti-IgE, may need to be considered and these are best carried out by a specialist pediatric pulmonologist. Further developments in the use of noninvasive biomarkers to help individualize treatment will be helpful in the future treatment of severe asthma.