Asthma Management in Children Under 12 Years

Treatment Recommendations

The American Academy of Pediatrics recommends low-dose inhaled corticosteroids (ICS) as the preferred first-line controller therapy for persistent asthma in children under 5 years 1, 2, 3
The Global Initiative for Asthma (GINA) suggests that budesonide nebulizer solution is a preferred formulation for children under 4 years who cannot effectively use other devices 3
The National Asthma Education and Prevention Program recommends initiating daily long-term controller therapy when symptoms require treatment more than 2 times per week, or when severe exacerbations require beta-agonist more frequently than every 4 hours over 24 hours 3
The American College of Allergy, Asthma, and Immunology recommends assessing response to therapy within 4-6 weeks, and considering alternative therapies or diagnoses if clear benefit is not observed within this timeframe 1

The American Academy of Allergy, Asthma, and Immunology suggests that leukotriene receptor antagonists (LTRAs) such as montelukast may be used as an alternative option for children who cannot use ICS 1, 2
The European Respiratory Society recommends considering LTRAs when inhaled medication delivery is suboptimal due to poor technique or adherence issues 3

The National Institutes of Health recommends two preferred options for step-up therapy: adding long-acting inhaled beta2-agonists (LABA) to low-dose ICS, or increasing the dose of ICS within the medium-dose range 1
The American Thoracic Society suggests that salmeterol DPI is FDA-approved only for children 4 years and older, and LABAs should never be used as monotherapy 3

The Pediatrics society recommends that for children with allergic asthma aged 5 years and older with controlled symptoms, subcutaneous immunotherapy (SCIT) may be considered as an adjunct treatment 4, 1
The Journal of Allergy and Clinical Immunology suggests that fractional exhaled nitric oxide (FeNO) measurement can be added as part of an ongoing asthma monitoring and management strategy 4

The American Academy of Pediatrics states that the benefits of ICS clearly outweigh concerns about potential adverse effects in children 3
The National Asthma Education and Prevention Program reports that strong evidence from clinical trials suggests that ICS at recommended doses do not have long-term, clinically significant, or irreversible effects on vertical growth, bone mineral density, ocular toxicity, or suppression of adrenal/pituitary axis 1