Article Text

Difficult asthma: beyond the guidelines
  1. BRYAN LASK, Consultant Psychiatrist
  1. St George’s Hospital Medical School
  2. Cranmer Terrace, London SW17 0RE, UK

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    Editor,—I write to draw attention to the fact that in his review “Difficult asthma: beyond the guidelines” Balfour-Lynn1 has omitted any reference to one of the most important components. Although he refers to problems of adherence to treatment, this is by no means the only important psychosocial component of difficult asthma. Psychophysiological responsivity to emotional challenges in children with asthma and the role of emotional factors in childhood asthma have been well documented over very many years.2 3 The role of psychological factors in fatal childhood asthma have been clearly established.4

    Numerous forms of psychological interventions have been shown to have clinically significant effectiveness in randomised controlled trials.5-8 There can no longer be any dispute about the relevance of psychosocial factors in the triggering and maintenance of episodes of asthma.9 What is now required is for paediatricians to pay more attention in practice to current knowledge, for so long as they do not, there will continue to be avoidable instances of “difficult asthma.”

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    Dr Balfour-Lynn comments:

    I agree entirely with Dr Lask that there are important psychosocial components to difficult asthma. For this reason I stated in the article that it was not uncommon for psychosocial aspects to play a large role in the wellbeing of a child, and particularly an adolescent with asthma. I also emphasised that asthma and psychological disturbance must both be treated on their own merits without necessarily deciding which is primary and which secondary. In the paediatric respiratory unit at the Royal Brompton Hospital in London, UK, our clinical psychologists are a valued part of our multidisciplinary approach to these difficult patients.

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