Difficult-to-treat asthma: how far to investigate?

Difficult-to-treat asthma (DTA) is an heterogeneous condition associated wi th uncontrolled asthma despite optimum treatment. Management of DTA in chil dren requires: 1)to exclude alternative diagnosis (vocal cord dysfunctionin g, cystic fibrosis, primary ciliary dyskinesia, hypereosinophilia, bronchop ulmonary dysplasia, sequelae of viral infection); 2) to assess compliance, underuse of asthma medication being the main cause of avoidable DTA; and 3) to look for either precipitating or environmental factors, gastroesophagea l reflux, or sinusitis. Medical teatment is based upon optimization of educ ation and association of antiinflammatory and bronchodilator drugs. (C) 200 0 Editions scientifiques et medicales Elsevier SAS.