**Monitoring Asthma in Childhood: Still a Challenge**

Patricia W. Garcia-Marcos, Manuel Sanchez-Solis and Luis Garcia-Marcos

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/62465

#### **Abstract**

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Asthma monitoring should be focused on patient outcomes and goals. Using clinical practice tools allows the clinicians to detect problems such as bad adherence to mainte‐ nance therapy, comorbidities, or other external reason for a poorly controlled asthma. To succeed in the process of asthma control, doctors need the participation of the family. Because such educational task requires good agreement between patient environment and doctor, it might be difficult to achieve. However, it is worth to implement because the benefit is a life without symptoms of asthma with a minimum medication.

**Keywords:** Noncontrolled asthma, management, adherence, children, monitoring

#### **1. Introduction**

Asthma is the most common chronic disease in childhood. It is clinically characterized by episodes of wheezing, dyspnea, cough, and chest tightness with different grades of severity. Most patients are free of symptoms between these episodes or "attacks," either because asthma is well controlled or because it is the natural course of the disease [1, 2]. Although this episo‐ dic nature can make patients, parents, and health care professionals interpret asthma as an acute or intermittent disease when episodes are infrequent, asthma is in fact a chronic disease characterized by ongoing inflammation of the airway mucosa, even when the patient is asymptomatic. Successful long-term management of the disease therefore requires careful

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follow-up and monitoring. However, guidelines on asthma do not provide recommendations that are unanimous [3].

An overwhelming number of 334 million people suffer from asthma worldwide. The most recent global survey calculates that 14% of children experience asthma symptoms [4]. It is difficult to quantify the global economic burden of asthma, but estimates are high enough to encourage active interventions. The indirect costs for children, which are not insignificant, include school Absenteeism; whereas the direct costs are even larger, and include costs from hospitalization, emergency department (ED) visits, unscheduled doctor or nurse visits, and medication. Controlled asthma imposes far less of an economic burden. Strategies towards improving access and adherence to evidence-based therapies are, therefore, likely to be effective in reducing the economic burden of asthma [3, 5]. One of the basics for this goal in developed countries, where access to care and medication is already guaranteed, would be to achieve and maintain asthma control with the least possible medication [6]. In keeping with this paradigm, the concept of problematic severe asthma has been used to describe children who have uncontrolled asthma despite being prescribed multiple controller therapies, including inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), and leukotriene receptor antagonists (LTRA). However, only a minority of children with uncontrolled or problematic severe asthma have true therapy-resistant asthma [7, 8]. Most children with poorly controlled asthma can be in fact well controlled by addressing the basics of asthma manage‐ ment, including patient and parent education, achieving and maintaining correct inhalation technique, avoiding exposure to relevant allergens and irritants, identifying and treating comorbidities, and, perhaps most importantly, identifying poor adherence and helping patients and parents to improve it.

This chapter reviews the recommendations on how to monitor asthma during childhood, focusing on patient outcomes and goals. Using some clinical tools will allow the clinicians to detect situations, such as poor adherence to maintenance therapy, comorbidities, or other external reasons for uncontrolled asthma. To reach a high degree of success, the participation of the whole family in the process of asthma control is needed. Such educational task requires good agreement between the patient, parents, and the health care professionals, which may be difficult to achieve. Despite these difficulties, it is worthwhile to try and implement, as the benefit is a good quality of life for the patient with asthma. We will also search in this chapter for evidence on reliable direct instruments that may be helpful to achieve asthma control.
