Asthma Management in Children

Inhaled Corticosteroids for Long-Term Control

The American Academy of Allergy, Asthma, and Immunology recommends inhaled corticosteroids as the preferred first-line maintenance therapy for children with persistent asthma, with strong evidence establishing improved long-term outcomes compared to as-needed beta2-agonists 1
Inhaled corticosteroids improve lung function, reduce hyperresponsiveness, and result in better symptom scores, fewer courses of oral corticosteroids, and fewer urgent care visits or hospitalizations in children with mild or moderate persistent asthma 1, 2
For children 5 years and older with mild persistent asthma, low-dose inhaled corticosteroids are the preferred therapy, according to the American Academy of Pediatrics 1, 3
For children younger than 5 years with persistent asthma, low-dose inhaled corticosteroids delivered via nebulizer, dry powder inhaler (DPI), or metered-dose inhaler (MDI) with holding chamber are recommended by the American Academy of Allergy, Asthma, and Immunology 1, 4

Budesonide nebulizer solution is approved for children 1-8 years with persistent asthma, as recommended by the FDA 4
Fluticasone DPI is approved for children 4 years and older with persistent asthma, according to the FDA 4

Studies show that inhaled corticosteroids are more effective than cromolyn, nedocromil, theophylline, or leukotriene receptor antagonists (LTRAs) in improving asthma outcomes in children, as reported by the American College of Allergy, Asthma, and Immunology 1, 3

For children under 5 years with persistent asthma, treatment recommendations are based on extrapolation from studies in older children, according to the American Academy of Pediatrics 1, 4
For infants and young children with recurrent wheezing and risk factors for persistent asthma, inhaled corticosteroids are the preferred treatment option, as recommended by the American Academy of Allergy, Asthma, and Immunology 4
For moderate persistent asthma in children under 5 years not controlled on low-dose ICS, options include increasing to medium-dose ICS or adding a long-acting beta2-agonist to low-dose ICS, according to the American College of Allergy, Asthma, and Immunology 5

Response to therapy should be carefully monitored, and if no clear benefit is observed within 4-6 weeks, alternative therapies or diagnoses should be considered, as recommended by the American Academy of Allergy, Asthma, and Immunology 5
When benefits are sustained for 2-4 months, a step down in therapy should be attempted, according to the American College of Allergy, Asthma, and Immunology 5