Half of all children sent to a specialist to care for severe asthma that does not respond to treatment have been given the wrong diagnosis or are not taking their medication correctly, according to a new study.

The researchers reviewed studies on severe asthma   published between 1995 and 2010 and also used data from their personal clinical practice to produce recommendations for the management of severe asthma in children.

The studies showed that in many instances, what were thought to be cases of treatment-resistant asthma actually occur because of poor management of basic asthma care. For instance, children may not adhere to their treatment properly, they may be given the wrong medication dose or not take it often enough, or they may use their inhaler incorrectly. Also, children may not be minimizing their exposure to environmental triggers such as allergens and smoke.

The studies reported that less than 50 percent of children referred to specialist care with problematic severe asthma have true therapy-resistant asthma.

To tackle severe asthma and prevent misdiagnosis, the researchers recommend:

  • Physicians perform a detailed re-evaluation to confirm the diagnosis and ensure that basic management strategies are being dealt with correctly.
  • Children be examined to see whether their asthma is exacerbated by other conditions, such as dysfunctional breathing, obesity or food allergies  .
  • Physicians check to see whether a child's asthma improves when potentially reversible basics, such as poor adherence to treatment, are corrected; or if they have true treatment-resistant asthma that is still symptomatic even when the basics have been addressed.

The review, published in this week's European Respiratory Society meeting special edition of The Lancet, concludes: "Despite the interest in innovative approaches, getting the basics right in children with apparently severe asthma will remain the foundation of management in the foreseeable future."

The study was conducted by Andrew Bush and Sejal Saglani from Imperial College London and the Royal Brompton Harefield National Health Service Foundation Trust in the United Kingdom.