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Medicina
Special Issues
Diagnosis and Treatment of Severe Asthma
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Diagnosis and Treatment of Severe Asthma

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (15 February 2025) | Viewed by 3456

Special Issue Editor

Prof. Dr. Mikhail Kazachkov

E-Mail Website
Guest Editor
Department of Pediatric Pulmonology, New York University School of Medicine, New York, NY, USA
Interests: respiratory; asthma; cough; pediatric pulmonology

Special Issue Information

Dear Colleagues,

It is a pleasure to invite you to contribute to this Special Issue. 

The ERS/ATS taskforce defines severe uncontrolled asthma (SUA) as, “asthma which requires treatment with high dose inhaled corticosteroids (ICS) plus a second controller (and/or systemic corticosteroids) to prevent it from becoming ‘uncontrolled’ or which remains uncontrolled despite this therapy”. 

It is important to state that severe uncontrolled asthma shall be diagnosed only after considerable effort is made to address potential complicating factors, primarily medication adherence, as well as medication administration techniques, allergen exposure, smoking, and others.  When this diagnostic criteria is applied, approximately 5% of patients with asthma fit the diagnosis of SUA.  Considering the fact that asthma affects millions of patients in different countries, it is apparent that the burden of SUA is high. The obvious link between SUA in children and the development of COPD later in life makes it imperative that the SUA is managed appropriately and full controlled is achieved.

Given the extremely high interest in this topic from both researchers and medical practitioners, Medicina is launching a Special Issue entitled "Diagnosis and Treatment of Severe Asthma".  The aim of this Special Issue is to explore the issues related to the pathogenesis of SUA, with special attention paid to its phenotypes and the role of complicating factors which affect its management.

We are pleased to invite submissions of original articles concerning basic and clinical research in severe asthma in children and adults, as well as interesting case reports, perspectives, reviews, systematic reviews, and meta-analyses focusing on topics including, but not limited to, the following:

  • Phenotypes and endotypes of SUA, with special attention paid to airway sampling;
  • Airway remodeling and its potential management;
  • Eosinophilic and reflux esophagitis as an important example of comorbidity for SUA;
  • Role of obesity in SUA;
  • Strategies for choosing biological medications for SUA.

Prof. Dr. Mikhail Kazachkov
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • severe asthma
  • severe pediatric asthma
  • asthma phenotypes
  • asthma comorbidities
  • esophagitis and asthma
  • biological medications for asthma

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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Research

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10 pages, 266 KiB  
Article
Evaluation of Asthma Course in Patients Hospitalized in Pediatric Intensive Care Unit Due to Severe Asthma Exacerbation
by Ahmet Selmanoglu, Hatice Irmak Celik, Cankat Genis, Esra Kockuzu, Zeynep Sengul Emeksiz and Emine Dibek Misirlioglu
Medicina 2025, 61(2), 341; https://doi.org/10.3390/medicina61020341 - 14 Feb 2025
Viewed by 1165
Abstract
Background and Objectives: Childhood asthma represents a significant global public health issue and is the most common chronic disease among children. Hospitalization costs, especially for intensive care, are quite high. This study aimed to evaluate the characteristics, prognosis, and preventable risk factors [...] Read more.
Background and Objectives: Childhood asthma represents a significant global public health issue and is the most common chronic disease among children. Hospitalization costs, especially for intensive care, are quite high. This study aimed to evaluate the characteristics, prognosis, and preventable risk factors of patients admitted to the Pediatric Intensive Care Unit (PICU) due to severe asthma exacerbations. Materials and Methods: We assessed patients admitted to the Ankara Bilkent City Hospital PICU from January 2013 to December 2022 diagnosed with asthma based on The Global Initiative for Asthma (GINA) criteria. The collected data encompassed demographic and clinical characteristics, intensive care treatments, hospitalization duration, atopic conditions, and respiratory viral panel results. The current clinical status was assessed using hospital records and caregiver interviews, with a focus on recent emergency admissions, ongoing treatments, exacerbation frequency, and asthma control based on GINA guidelines. Results: The study comprised 83 patients with a mean age of 72.9 (±45.5) months, predominantly male (63.9%). The average follow-up duration post-discharge was 40.7 ± 26.9 months. Patients received respiratory support in the PICU for a mean of 3.8 (±2.8) days and systemic steroid therapy for 4 (±1.5) days. Respiratory viral panel results identified pathogens in 42 patients, with rhinovirus being the most frequent. Post-discharge, 72.3% of patients continued follow-up at pediatric allergy clinics. Of the 60 patients contacted, 67.5% were on current asthma treatment and 48.2% had experienced an exacerbation in the past year. Asthma management steps remained unchanged for 33 patients, decreased for 13, and increased for 47 (44.6%). Asthma maintenance treatments pre-admission and post-discharge showed that 44.6% (n = 47) of the patients required an increase in their GINA treatment step after PICU admission, which was statistically significant (p < 0.001). History of atopic dermatitis was a significant risk factor for escalating treatment steps in both univariate and multivariate analyses (p = 0.018, p = 0.03). Conclusions: We found that admission to the PICU due to severe asthma exacerbation not only increases the risk of recurrent asthma exacerbations but also serves as a risk factor for stepping up maintenance treatment according to GINA guidelines during long-term follow-up. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Severe Asthma)

Review

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20 pages, 385 KiB  
Review
Evaluating Severe Therapy-Resistant Asthma in Children: Diagnostic and Therapeutic Strategies
by Andrew Bush
Medicina 2024, 60(11), 1799; https://doi.org/10.3390/medicina60111799 - 2 Nov 2024
Cited by 2 | Viewed by 1840
Abstract
Introduction: Worldwide, asthma is the most common non-communicable respiratory disease and causes considerable morbidity and mortality. Most people with asthma can be treated effectively with low-dose medications if these are taken correctly and regularly. Around 10% of people with asthma have an [...] Read more.
Introduction: Worldwide, asthma is the most common non-communicable respiratory disease and causes considerable morbidity and mortality. Most people with asthma can be treated effectively with low-dose medications if these are taken correctly and regularly. Around 10% of people with asthma have an uncontrolled form of the disease or can only achieve control with high-dose medications, incurring disproportionately high health care costs. Areas Covered: PubMed and personal archives were searched for relevant articles on the definition, management and pharmacotherapy of severe asthma. The WHO classification of severe asthma and the treatment levels encompassed in the definition are discussed. Most children and young people referred for consideration of ‘beyond-guidelines therapy’ can in fact be managed on standard treatment after a multi-disciplinary team assessment focusing on ensuring correct basic management, and these steps are described in detail. Options for those with true therapy-resistant asthma are described. These include monoclonal antibodies, most of which target type 2 inflammation. Expert Opinion: Getting the basics right is still the most important aspect of asthma care. For those with severe, therapy-resistant asthma, an increasing number of life-transforming monoclonals have been developed, but there is still little understanding of, and a paucity of treatment options for, non-eosinophilic asthma. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Severe Asthma)
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