Purpose of review: The aim of this article is to examine the evidence for the effectiveness of systemic corticosteroids in managing acute asthma in children as it relates to the timing of its administration. Recent findings: Three themes relevant to the timing of systemic corticosteroid administration as it relates to managing acute asthma in children are addressed, namely the evidence for early administration of systemic corticosteroid; factors associated with the administration of systemic corticosteroids and evidence for nurse-initiated administration of systemic corticosteroid. Summary: There is a clear inverse relationship between time elapsed from the intake of systemic corticosteroids to disposition and the risk of admission. The variable timing of systemic corticosteroid may explain the variable success of clinical care pathways to manage acute asthma. Recent studies have documented a significant reduction hospital admission with early administration of systemic corticosteroid. For acute asthma pathways to succeed in improving hospital admission rates, implementation of such pathways must be linked to barriers to the administration of systemic corticosteroids. Findings from the studies cited provide guidance in the administration of systemic corticosteroids in children with asthma in the real life setting of an emergency department.

Purpose of review: Induced sputum provides a noninvasive way of assessing airway disease. This has led to the identification of different phenotypes of asthma and the potential for individualized treatment targeted at specific pathological processes. However, practical issues limit the frequent use of this technique. This review assesses the extent to which induced sputum can distinguish between asthma phenotypes and guide treatment. Recent findings: Although the short-term repeatability of sputum analysis is good, recent research has shown a great deal of variability in sputum inflammatory profiles over follow-up periods of several months to a few years. In particular, the distinction between eosinophilic and noneosinophilic asthma is not consistent in many individuals. These findings suggest that persistent asthma phenotypes cannot be determined using a single sputum sample. Recent studies have also cast doubt on previous findings that noneosinophilic asthma is unresponsive to corticosteroid treatment. Summary: Sputum inflammatory profiles are not consistent over time and a persistent asthma phenotype cannot be reliably determined using a single induced sputum. Because time and cost issues prohibit frequent induced sputum analyses in most clinical settings, these findings limit the diagnostic and therapeutic value of sputum analysis for clincal practice.

Purpose of review: Although current asthma guidelines stress the importance of assessing and enhancing adherence to asthma treatment, medication adherence rates in asthma patients are consistently low in practice. In this review, we summarize current literature on method of measurement, prevalence, outcome and intervention of medication adherence in asthma patients. Recent findings: Nonadherence to prescribed treatment continues to be a frequent problem in patients with asthma even in recent years. Objective measurement of adherence should be implemented whenever possible. Review of pharmacy refill data or electronic monitoring of inhaler actuation may be a preferred method to assess adherence. Educational programmes should be specifically designed to address the unmet need and specific reasons for nonadherence for the target population. Large, well designed clinical trials to assess the efficacy of remote electronic monitoring and reminder systems to improve adherence are needed. Summary: There is an urgent clinical need for systematic, proven methods to assess and address medication nonadherence in asthma patients.

Purpose of review: Asthma is one of the most prevalent chronic medical conditions to complicate pregnancy. With approximately one-third of women experiencing a worsening of control during the course of their pregnancy, identifying those at greatest risk has the potential to improve maternal and fetal outcomes for a large number of pregnancies. Similarly, active management strategies that prioritize asthma control in this vulnerable population can have a far-reaching impact. Recent findings: Demographic characteristics and patient noncompliance place certain populations of pregnant women at increased risk of poor asthma control during pregnancy. In addition, undertreatment and disparities in care of acute exacerbations during pregnancy likely contribute. Targeted educational interventions and treatment algorithms using objective markers of disease activity have shown improved outcomes in asthma control. Summary: Active management strategies which focus on identifying patient-specific risk factors, patient and provider education, and targeted treatment interventions can improve asthma care for women during pregnancy.