Quel est le profil d’un asthme sévère chez l’enfant ?

Severe asthma is estimated to occur in 9.6% of asthmatics. Even though severe asthma does not occur frequently in asthmatic children, still it accounts for 80% of health expenditures in this group of patients. International guidelines grade the severity of asthma in four stages (intermittent, mild persistent, moderate, severe) according to daytime and night time symptoms, the frequency of exacerbations that affect the patient's activities, and the forced expiratory volume in the first second (FEV₁) before starting treatment. This classification appears insufficient for an evaluation of the severity of asthma in children because it does not take into account their current treatment, namely, inhaled corticoids, as well as previous acute severe exacerbations, the condition of the lower airways, the existence of an atopic terrain, and the importance of the patient's age and sex on the severity of the asthma. Finally, it must be remembered that in the clinical workup of a child with severe asthma, it is first of all necessary to rule out “false asthma” (by systematic etiologic investigation), to distinguish between severe asthma and poorly controlled asthma related to co-existing conditions not otherwise considered, an inadequate environment, and poor adherence to prescribed therapy.