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Childhood asthma — Clinical Guidelines

Overview

Asthma is a chronic respiratory condition characterized by reversible airway inflammation, leading to symptoms such as wheezing, shortness of breath, chest tightness, and coughing, particularly in children 1 3 6.

Diagnosis

Recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, especially at night or after exercise 1 3.

Spirometry showing reversible airflow obstruction (increased FEV1/FVC ratio post-bronchodilator) 1 3.

Peak expiratory flow variability 1 3.

Allergy testing and history of atopic conditions may support diagnosis 1 3.

Management

First-line treatments:

- Inhaled corticosteroids (ICS) for persistent symptoms 1 3 6. - Short-acting beta-agonists (SABAs) for quick relief of symptoms 1 3 6.

Adjunctive treatments:

- Long-acting beta-agonists (LABAs) in combination with ICS for moderate to severe persistent asthma 1 3 6. - Leukotriene modifiers or mast cell stabilizers as add-on therapy in specific cases 1 3 6.

Special Populations

Pediatrics: Lower socioeconomic status (SES) is associated with higher odds of poorer health outcomes, including asthma 1 3.

Comorbidities: Early life antibiotic exposure correlates with increased risk of childhood asthma and other atopic conditions 6.

Key Recommendations

Utilize inhaled corticosteroids as first-line therapy for persistent asthma symptoms in children (Evidence: Strong 1 3 6).

Consider socioeconomic factors, as lower income levels are predictive of worse asthma outcomes, necessitating tailored support and interventions (Evidence: Moderate 1 3).

Monitor and manage early life exposures, such as antibiotic use, which may increase the risk of asthma and other chronic conditions (Evidence: Moderate 6).

References

1 Nwaonumah EC, Riggins AD, Masud N, Cowan LT, Chopak-Foss J, Oloyede T et al.. Exploring Income Inequality as a Predictor of Mental, Emotional, Developmental, Behavioural and Physical Health Outcomes in US Children. Child: care, health and development 2025. link 2 Nunez H, Nieto PA, Mars RA, Ghavami M, Sew Hoy C, Sukhum K. Early life gut microbiome and its impact on childhood health and chronic conditions. Gut microbes 2025. link 3 Meeks HD, Yu DZ, Fraser A, Maloney TN, Curtin K, Newman M et al.. Utilize administrative data to assess impact of individual-level and neighborhood-level socioeconomic status on childhood health in a longitudinal study. Public health 2025. link 4 Crouch E, Radcliff E, Brown MJ, Hung P. Association Between Positive Childhood Experiences and Childhood Flourishing Among US Children. Journal of developmental and behavioral pediatrics : JDBP 2023. link 5 Patil SS, Puttaswamy N, Sarode SC, Sarode GS, Patil SS, Cardenas A et al.. Environmental tobacco smoke and children's health: a bibliometric and altmetric analysis of 100 most cited articles. BMC public health 2023. link 6 Aversa Z, Atkinson EJ, Schafer MJ, Theiler RN, Rocca WA, Blaser MJ et al.. Association of Infant Antibiotic Exposure With Childhood Health Outcomes. Mayo Clinic proceedings 2021. link 7 Kwon J, Kim SW, Ungar WJ, Tsiplova K, Madan J, Petrou S. A Systematic Review and Meta-analysis of Childhood Health Utilities. Medical decision making : an international journal of the Society for Medical Decision Making 2018. link 8 Mikkonen J, Moustgaard H, Remes H, Martikainen P. The Population Impact of Childhood Health Conditions on Dropout from Upper-Secondary Education. The Journal of pediatrics 2018. link 9 Attlee T. Cranio-sacral therapy and the treatment of common childhood conditions. Health visitor 1994. link

Childhood asthma