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Escalate care
If a diagnosis of asthma is confirmed and technique and adherence have been determined to be adequate, then escalation of care per asthma care guidelines is the next appropriate step (Global Strategy for Asthma Management and Prevention, http://bit.ly/2a5yu1w). Referral to a pediatric asthma specialist should be considered as well.
Some patients may require a step up to biologic therapies to control asthma. Biologic therapies used in pediatric patients include omalizumab, an anti-IgE antibody that has been shown to reduce exacerbations in children ages 6 and older with severe asthma. Mepolizumab is an anti-IL-5 antibody used in children 12 years of age and older with eosinophilic asthma. Numerous other immunomodulatory drugs for the treatment of severe asthma also are in the pipeline.
Amanda demonstrated appropriate technique, but it was determined that her adherence to medications was very poor. Her pediatrician continues to work with her on modifying her behavior to ensure that she takes her medication appropriately and gets her asthma under control. This is a test.
Dr. Hoch is a member of the AAP Section on Pediatric Pulmonology and Sleep Medicine Executive Committee.
Copyright © 2016 American Academy of Pediatrics
