It is critical to confirm a diagnosis of asthma and exclude alternative diagnoses. Co-morbidity conditions can also contribute to worsened symptoms and reduced response to therapy.
Unequivocal demonstration of diagnostic criteria for asthma, unequivocal evidence of adherence and effective inhaler technique, and elimination of possible co-morbidities must be documented before assigning the label ‘severe asthma’. Fortunately, true severe asthma in children appears to be very uncommon.
Consider the following approaches to identify either alternative diagnoses or co-morbidities in children with suspected severe asthma.