Acute severe asthma in children. Issues related to management.

Asthma is an inflammatory disease with easily recognized clinical signs and symptoms. The challenges in management of patients with asthma however are the recognition of the severity of the attack as well as an appreciation of sociobiological factors important in disease management. Recognition of disease severity depends on an appreciation of the child's past medical history, recognition of those prone to near fatal episodes of asthma and a close evaluation for the effect of hypoxia on target organs. Socio-biological factors include the contributions of race, ethnicity, and income and environmental triggers to disease severity and prevalence. Other challenges in asthma management include measurement of airway inflammation, challenges in the delivery of and recognition when emergency care fails, tailoring follow-up treatment, and standardization of hospital care. Intensive care management of asthma is not well standardized and relies on personal preferences and therapies that have not been well studied in children. The future of asthma care however is optimistic in that research to further characterize the pathophysiology of the disease, to standardize treatment options as well as genetic studies to pinpoint asthma susceptibility may lead to treatment being tailored for individual patients rather than using a trial and error approach.