3
Remarks
An atypical presentation of severe asthma includes such factors as, for example, excessive
mucus production, rapid decline in lung function, reduced carbon monoxide transfer
factor coefficient and the absence of atopy in a child with difficult asthma.
Because, at the present time, measurement of sputum eosinophils has not yet been
sufficiently standardized and is not widely available the ATS and ERS suggest such an
approach be used only in specialized centers experienced in this technique. Patients who
are likely to benefit from this approach are those who can produce sputum, demonstrate
persistent or at least intermittent eosinophilia and have severe asthma with frequent
exacerbations. Clinicians should recognize that different choices will be appropriate for
different patients.
