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Persistent symptoms despite step 4 therapy for at least 6 months require re-evaluation, optimization of baseline care, correction of inhaler technique and adherence, and structured education. Escalation includes targeted add-on therapy and biologics selected by type 2 biomarkers and comorbidity patterns, with follow-up at 16–24 weeks to evaluate symptom, exacerbation, lung function, and biomarker trends.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/an-algorithm-for-the-diagnosis-and-management-of-severe-asthma-in-children-and-adolescents/446916/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/an-algorithm-for-the-diagnosis-and-management-of-severe-asthma-in-children-and-adolescents/446916.png","ImageObject",300,407,{"name":92,"@type":93},"Anna Hans","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-10","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How is severe asthma diagnosis confirmed before escalation?","Question",{"text":112,"@type":113},"Alternative or coexisting diseases are excluded using history, lung function, imaging, and—when needed—bronchoscopy. Control and risk are then assessed with validated tools, recent exacerbations, systemic steroid bursts, and lung function impairment.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What steps are recommended when good control cannot be achieved?",{"text":117,"@type":113},"Modifiable factors are optimized, including adherence and correct inhaler technique, trigger exposure, and unrecognized comorbidities. Baseline care is optimized and structured asthma education is offered, alongside pulmonary rehabilitation and MART with low-dose ICS formoterol where licensed.",{"name":119,"@type":110,"acceptedAnswer":120},"How are biologic therapies selected in children and adolescents with type 2 asthma?",{"text":121,"@type":113},"Biomarkers such as blood eosinophils, FeNO, and total/specific IgE with sensitization support a type 2-high phenotype. Omalizumab is used for IgE-mediated allergic asthma, mepolizumab or benralizumab for eosinophilic asthma, dupilumab for type 2-high with elevated biomarkers and atopic dermatitis, and tezepelumab for uncontrolled asthma regardless of IgE/eosinophils.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},446916,1791477154,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},5909892332657,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Allergy  \nNEWS AND VIEWS  OPEN ACCESS   \nAlgorithms in Allergy and Clinical Immunology  \nAn Algorithm for the Diagnosis and Management of Severe Asthma in Children and Adolescents  \nEckard Hamelmann1  | Bianca Schaub2,3  | Susanne Lau4  | Leonard B. Bacharier5   \n1Department of Paediatrics, Children's Center Bethel, Bielefeld, University Hospital OWL, University of Bielefeld, Germany | 2Department of Pulmonary and Allergy, Dept. of Paediatrics, Dr von Hauner Children's Hospital, University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany | 3Comprehensive Pneumology Center (CPC-M), LMU Munich, Member of the German Center for Lung Research (DZL), and German Center for Child and Adolescent Health (DZKJ), Dr von Hauner Children's Hospital, LMU Munich, Germany | 4Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany | 5Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Tennessee, USA  \nCorrespondence: Eckard Hamelmann ([eckard.hamelmann@uni-bielefeld.de](eckard.hamelmann@uni-bielefeld.de))  \nReceived: 27 June 2025 | Revised: 13 August 2025 | Accepted: 18 August 2025  \nFunding: The authors received no specific funding for this work.  \nKeywords: asthma | asthma treatment | biologics | paediatrics | severe asthma  \nDTA is present when good control cannot be achieved for 3. Optimise baseline care—verify therapy adherence and in-  \n≥6months under step 4 therapy (medium-dose inhaled corti- spiratory flow, coach inhaler technique, prescribe a writcosteroids [ICS] + long-acting β2 agonist or equivalent) owing ten action plan, offer structured asthma education and to modifiable factors such as poor adherence, faulty inhalation consider pulmonary rehabilitation and MART with low  \ntechnique, trigger exposure or untreated comorbidities. dose ICS formoterol as reliever where licensed.  \nSA is diagnosed only after these factors are corrected and the di- 4. Address modifiable aggravating factors—reduce allergen agnosis of asthma is reconfirmed, yet uncontrolled asthma or the and tobacco exposure, manage psychosocial stress, correct  \nneed for high-dose ICS or medium-dose ICS plus another con- inhaler technique, ensure vaccination and treat chronic  \ntroller (long-acting beta-agonists and/or long-acting muscarinic infections.  \nantagonist) or biologic therapy (Step 5/6) persists. 5. Identify and treat comorbidities—especially allergic rhinitis, atopic dermatitis, food allergy, chronic rhinosinusitis,  \nThis definition is consistent with the 2025 German S1 guideline,  \nthe 2024 National Asthma Guideline and GINA 2025 [1–3] . gastrooesophageal reflux, obesity and sleep apnoea.  \n6. Reevaluate—if control remains poor despite ≥3months of  \n1. Confirm the diagnosis—exclude alternative or coexisting  \ndiseases (e.g., cystic fibrosis, primary ciliary dyskinesia, optimiseand targdetSteedpb5iotlhoerapgics,y,procprefeereadbltoyipnheanoptyaepe assdiatriecsssmeveenrte immunodeficiency, postinfectious bronchiolitis obliterans asthma centre.  \nand inducible laryngeal obstruction) by history, lung func  \ntion, imaging and, when indicated, bronchoscopy. Most paediatric SA is type 2 high. Persistent elevation of bio-  \n2. Assess control and risk—use validated tools (cACT/ACT, markers predicts both higher exacerbation risk and superior bioACQ) and document recent exacerbations, systemic steroid logic response. Integration of clinical phenotype with biomarker bursts and lung function impairment. pattern, age, dosing logistics (such as weight-based dosing of  \n\n| [Correction added on 18 September 2025, after first online publication: Abstracts and subsections are removed.] Susanne Lau eckard and Leonard B. Bacharier contributed equally (shared last authorship) |\n| --- |\n| This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in","cbCaisyvnkTPnnez","https://ap.wps.com/l/cbCaisyvnkTPnnez","pdf",647133,"English","# News and Views\n## Algorithms in Allergy and Clinical Immunology\n## Diagnostic and Management Algorithm for Severe Asthma in Children and Adolescents\n## Stepwise Assessment and Treatment Strategy\n## Biomarkers and Biologic Selection\n## Treatment Response Targets and Follow-up","[{\"question\":\"How is severe asthma diagnosis confirmed before escalation?\",\"answer\":\"Alternative or coexisting diseases are excluded using history, lung function, imaging, and—when needed—bronchoscopy. Control and risk are then assessed with validated tools, recent exacerbations, systemic steroid bursts, and lung function impairment.\"},{\"question\":\"What steps are recommended when good control cannot be achieved?\",\"answer\":\"Modifiable factors are optimized, including adherence and correct inhaler technique, trigger exposure, and unrecognized comorbidities. Baseline care is optimized and structured asthma education is offered, alongside pulmonary rehabilitation and MART with low-dose ICS formoterol where licensed.\"},{\"question\":\"How are biologic therapies selected in children and adolescents with type 2 asthma?\",\"answer\":\"Biomarkers such as blood eosinophils, FeNO, and total/specific IgE with sensitization support a type 2-high phenotype. Omalizumab is used for IgE-mediated allergic asthma, mepolizumab or benralizumab for eosinophilic asthma, dupilumab for type 2-high with elevated biomarkers and atopic dermatitis, and tezepelumab for uncontrolled asthma regardless of IgE/eosinophils.\"}]","An Algorithm for the Diagnosis and Management of Severe Asthma in Children and Adolescents | PDF",1790717729]