Treatment of problematic severe asthma in children

This thesis examines difficulties in the treatment of asthma in children both from a psychosocial (behavioral) and a pathophysiological point of view. It aims to illuminate clues for further treatment in a deadlock situation for young patients with asthma. Especially internalizing behavioral problems such as being withdrawn/depressed and somatic complaints are more severe in problematic severe asthma in children and these problems correlate with less improvement in quality of life. Behavioral problems were not associated with a change of lung function measurements and asthma control during treatment.
Comorbidities such as obesity or allergic rhinitis are prevalent in children with asthma. This thesis focuses on lung function in obese children with and without asthma and investigates lung function changes after weight loss. It also provides a systematic review regarding treatment of allergic asthma by means of immunotherapy following the latest guideline methodology.
This thesis promotes a stepped approach for treatment of problematic severe asthma in children in which all of the involved health domains get attention. Multidisciplinary treatment is advocated, focusing on the basics as well as comorbidities and behavioral problems, in order to get the asthma treatable again.