Asthma in children

As asthma in children differs from adult asthma, child-specific asthma guidelines should be used and adult and adolescent guidelines should not be extrapolated to younger age groups.

The prevalence of childhood asthma appears to have plateaued in many affluent countries. However, asthma remains a significant cause of childhood morbidity and mortality, and is still a common problem managed in ambulatory and emergency care settings.

Most children with asthma have mild intermittent asthma and do not require daily therapy. Minimum doses and medications for maximal control should be used in those who require preventative therapies. Therapy should be individualised.

A number of important differential diagnoses, adherence and environmental issues should be considered when evaluating a child with suspected asthma, especially in very young children or when high doses of inhaled corticosteroids are required.

Asthma is a chronic respiratory disorder characterised by variable airway inflammation, airway obstruction, and airway hyper-responsiveness. These features interact to determine the clinical symptom pattern of the individual. While the majority of asthmatic children have an intermittent symptom phenotype, the minority have persistent symptoms, reflecting the underlying chronic inflammation. In older children, as in adults, this may lead to permanent structural alterations of the airway wall (airway remodelling) and potentially a more severe asthma phenotype.

This topic covers the treatment of children up to 12 years of age. Children 12 years and older are grouped together with adults within national and international guidelines, and as such are treated in a similar manner as adults. Certain therapies remain only licensed for adults (≥18 years), such as combination ('triple') inhalers (containing inhaled corticosteroid, long-acting beta agonist, and long-acting muscarinic antagonist), bronchial thermoplasty, biological agents such as reslizumab, and azithromycin. See Asthma in adults for more information.