Severe and near-fatal asthma in children and adolescents.

: Near-fatal asthma attacks occur rather frequently in asthmatic patients during childhood and adolescence. Major risk factors appear to be the severity and/or treatment difficulties, which may be related to the characteristics of the disease but also to mistaken or delayed diagnosis, poor compliance to treatment, and psychosocial problems. Indeed, difficult-to-control asthma symptoms can be caused by other disorders mimicking asthma, by unidentified exacerbating factors, by low compliance with the prescribed therapy, by inability to use the devices correctly (metered-dose inhalers, dry powder inhalers, nebulizers) and by low perceptiveness of airway obstruction. Children and adolescents with severe, difficult-to-treat asthma should receive specialist assessment and follow-up. Pharmacologic intervention should be combined with a detailed education and action plan, designed to get the disease under control but also to meet patient' and parents desires.