Text Box: WHAT ARE THE CAUSES FOR PERSISTENT DIFFICULT ASTHMA IN CHILDREN IN A DEVELOPING COUNTRY ?
Paramesh H
Director, Lakeside Medical Center and Hospital, Bangalore, India

Aim: To find out the causes for non-responsive asthmatics to usual treatment referred by pediatricians.
Methods: 245 children who were diagnosed as asthma by practicing pediatricians and were on bronchodilators and anti-inflammatory drugs but with poor response were referred for opinion. All the children had detailed clinical evaluation chest & sinus X-ray, CBC, and IgE levels. Peak flow measurement on children over 4 years and spriometry on children over        6 years.
Results: Out of 243 referred difficult asthma cases, children of 0-5 years were 184, 5-10 years 47, 10-15 years 12. 155 male and 88 female children of them. 102 (41.97 %) needed only reconfirmation of diagnosis, confidence, hope and re-strengthening their trust in the referred physician. 141 (58.03 %) had associated complications and or conditions to be tackled such as - sinusitis-60 (34.8 %), allergic rhinitis-42 (34.8 %), pneumonia-10 (5.8 %), non-compliance of medication-32 (18.5 %), poor technique of inhalation-25 (14.5 %), atelectesis from mucus plug-5 (2.9 %), tuberculosis-3 (1.7 %), steroid dependent-3 (1.7 %), VSD-1 (0.03 %) and pertusis syndrome-5 (2.9 %).
Conclusion: In referred patients with persistent difficult asthma, 41.97 % of them needed reconfirmation and development of trust in the referred physician. 58.03 % of patients had associated problems with asthma. Most common problems were sinusitis, allergic rhinitis, non-compliance of medication, poor inhalation technique, pneumonia and atelectesis from mucus plug. Other associated diseases like tuberculosis and pertusis syndrome, steroid dependence were less common.
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