Pediatric Asthma Management Guidelines

Controller Medication Selection

The American Academy of Allergy, Asthma, and Immunology recommends low-dose inhaled corticosteroids as the preferred first-line controller therapy for children with persistent asthma, with combination ICS/LABA reserved for those inadequately controlled on ICS monotherapy 1
For children ≥5 years with mild persistent asthma, the preferred therapy is low-dose inhaled corticosteroids, such as fluticasone 100 mcg or budesonide equivalent 1
Alternative therapies for children ≥5 years with mild persistent asthma include cromolyn, leukotriene receptor antagonists, nedocromil, and sustained-release theophylline 1

Life-threatening features of acute severe asthma in children include being too breathless to talk or feed, respiratory rate >50 breaths/min, pulse >140 beats/min, peak expiratory flow (PEF) <50% predicted, and PEF <33% predicted with cyanosis, silent chest, fatigue, or altered consciousness 2, 3, 4
First-line therapy for acute asthma exacerbations consists of three simultaneous interventions: high-flow oxygen via face mask, nebulized salbutamol, and intravenous hydrocortisone 2, 3, 4, 5
The British Thoracic Society recommends adding ipratropium 100 mcg nebulized every 6 hours for moderate to severe exacerbations 2, 3, 5

Children may be discharged when they have been on discharge medications for 24 hours with verified inhaler technique, PEF >75% of predicted or best, PEF diurnal variability <25%, and have a prescribed oral steroids, inhaled steroids, and bronchodilators 1, 2, 3, 4
The American Academy of Pediatrics recommends scheduling a follow-up appointment with a GP within 1 week and a respiratory clinic follow-up within 4 weeks 3

Essential components of self-management education for families include training in proper inhaler technique and peak flow meter use, understanding the difference between relievers and preventers, and recognition of worsening asthma signs 2, 3, 6
A written action plan should include monitoring symptoms, peak flow, and medication use, prearranged patient-initiated actions, and written guidance on when to increase ICS, start oral steroids, or seek urgent care 2, 4