Therapie des schweren Asthmas im Kindesalter

Zusammenfassung

Der Anteil von Patienten mit schwerem Asthma wird auf <5 % aller Kinder und Jugendlichen mit Asthma bronchiale geschätzt. Bei ihnen besteht trotz hochdosierter Therapie keine oder nur unzureichende Kontrolle über die Erkrankung, was mit einer signifikanten Morbidität und Einschränkung der Lebensqualität assoziiert ist und einen Risikofaktor für die Entwicklung einer chronisch obstruktiven Lungenerkrankung im späteren Lebensalter darstellt. Eine strukturierte, multidisziplinäre Evaluation der Patienten sollte zunächst die Diagnose Asthma bestätigen und eine angemessene Therapieadhärenz sichern. Des Weiteren sollten mögliche Komorbiditäten und aggravierende Faktoren identifiziert und ggf. behandelt bzw. eliminiert werden. Wird unter gesicherter Kombinationstherapie aus ICD und LABA und/oder LTRA keine Erkrankungskontrolle erreicht, steht Patienten mit allergischem Asthma Omalizumab als Therapieoption zur Verfügung. Jüngst wurde zudem Tiotropium als langwirksames Anticholinergikum zugelassen. Eine Dauertherapie mit systemischen Steroiden sollte vermieden werden. In Zukunft werden personalisierte Therapieansätze mit Biologika (z. B. anti- IL-5) die Behandlungsoptionen bei schwerem Asthma ergänzen.

Summary

An estimated 5 % of children and adolescents with asthma bronchiale suffer from severe asthma. In these patients, asthmatic symptoms persist in spite of antiinflammatory treatment. Severe asthma is associated with a significantly reduced quality of life and an increase in risk for COPD in later life. Besides insufficient compliance and medication intake, risk factors include polysensitization, strong atopy and exposure to environmental factors such as allergens, pathogens and tobacco smoke. Severe asthma should be treated in a multiprofessional setting. Central steps include the evaluation of medication intake and the identification and elimination/treatment of triggering factors and comorbidities. Besides adequate treatment with ICD and LABA or LTRA, anti-IgE can be applied in children with severe allergic asthma. Recently, also Tiotropium has been approved for children with severe asthma. Long-term systemic steroids should be avoided. In the future, personalized treatment options such as anti-IL-5 or other biologicals will significantly improve therapeutic opportunities for children with severe asthma.

Schlüsselwörter

Schweres Asthma - schwer therapierbares Asthma - therapierefraktäres Asthma - Biologika

Keywords

Severe asthma - difficult to treat asthma - therapy resistant asthma - treatment - diagnostic - biologicals

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