Asthma Management in Children

Age-Specific Recommendations

For children aged 5 years and older with moderate to severe persistent asthma, the American Academy of Allergy, Asthma, and Immunology recommends ICS-formoterol as single maintenance and reliever therapy, with age-appropriate ICS dosing in the formulation 1, 2
The American Academy of Pediatrics does not recommend SMART for children under 5 years, as no evidence supports the use of ICS-formoterol as maintenance and reliever therapy in this age group 2
For children aged 5-11 years, the National Asthma Education and Prevention Program recommends ICS-formoterol as SMART at Steps 3 and 4 for moderate to severe persistent asthma, with a conditional recommendation and moderate certainty of evidence 1, 2, 4
For adolescents aged 12 years and older, the American Academy of Allergy, Asthma, and Immunology strongly recommends ICS-formoterol as SMART at Steps 3 and 4, with a strong recommendation and high certainty of evidence 1, 4, 5

The Global Initiative for Asthma guidelines do not endorse SMART for children aged 5-11 years, differing from the National Asthma Education and Prevention Program guidelines 1
Avoid using SMART in children under 5 years, as no evidence supports safety or efficacy in this age group, and instead use conventional low-dose ICS with separate SABA reliever 2, 3

The American Academy of Pediatrics recommends evaluating response to therapy within 4-6 weeks of initiation, assessing symptom control, exacerbation frequency, and adherence 3
Monitor for signs of asthma control at each visit, and track total daily inhaler use to indicate poor control 5
Consider step-down therapy once control is sustained for at least 3 months, and do not increase ICS dose during exacerbations in adherent patients 1, 2, 3
Monitor growth in pediatric patients on long-term ICS therapy, as recommended by the American Academy of Allergy, Asthma, and Immunology 6