ABSTRACT
In our practice, children with problematic, severe asthma are severely disabled. We studied 71 children (35 male), 21 of whom were using regular oral steroids [Bossley et al. 2009]. The mean dose of fl uticasone equivalent was 1 mg/day, range 0.5 to 3 mg/day. They had a median of 2 admissions to hospital, range 0-21, and 12 were ventilated on at least one occasion. Mean fi rst second forced expired volume in one second (FEV1) was 76% (range 33-125), and despite prescribed medication, median bronchodilator reversibility was 14% (range 12-106). 34% had persistent airfl ow limitation, defi ned here as FEV1 < 75% predicted despite prednisolone and high dose β-2 agonists. 97% had an asthma control test < 20. Median FeNO was 52 ppb (range 5-171, normal < 25). Atopy was common, with more than 50% being skin prick test (SPT) positive to house dust mite (HDM), grasses, cat and dog. Food sensitivity at least as judged by SPT was common (peanut 25%, egg and milk 5-10%).
