Asthma is one of the most common chronic conditions affecting children today. About 6 million children in the United States ages 0-17 years have asthma, making it essential for parents and caregivers to understand effective management strategies. With proper care and the right approach, children with asthma can lead active, healthy lives.
Understanding Childhood Asthma
Pediatric asthma is characterized by variable expiratory airway limitation and persistent respiratory symptoms, including wheezing, coughing, shortness of breath, and chest tightness. Unlike adults, children face unique challenges with asthma management, including the need for age-appropriate treatments and education.
Asthma triggers extend beyond airborne agents, including respiratory infections, allergen exposure, environmental irritants, physical activity, hormonal fluctuations, medications, and psychosocial factors. Understanding these triggers is the first step in creating an effective management plan.
Evidence-Based Treatment Strategies
Medication Management
The cornerstone of asthma control is appropriate medication therapy. Treatment strategies focus on patient and caregiver education, regular symptom monitoring, and the implementation of stepwise tailored medication regimens based on symptom severity.Inhaled Corticosteroids (ICS): These remain the preferred controller medication for children with persistent asthma. Recent guidelines have expanded options for when and how to use these
medications effectively.
Intermittent ICS Therapy: New for the NHLBI guidelines, it's now recommended to use PRN albuterol and a short, seven to ten-day course of daily ICS as soon as the child got sick with a respiratory tract infection (RTI) for children 0-4 with recurrent wheezing.
SMART Therapy: For children with moderate to severe persistent asthma, EPR-4's recommended treatment is now a single inhaler with ICS and formoterol, aka Single Maintenance and Reliever Therapy (SMART), which simplifies treatment by using one medication as both a daily controller and rescue inhaler.
Environmental Control
Creating an asthma-friendly environment is crucial for symptom management. The health of children with asthma can be improved by promoting asthma control strategies, including asthma trigger reduction, appropriate guidelines-based medical management, and asthma education for children, parents, and others involved in asthma care.
Key environmental interventions include:
- Removing allergens like dust mites, pet dander, and mold from the home
- Ensuring smoke-free environments (tobacco and secondhand smoke)
- Maintaining good indoor air quality
- Managing temperature and humidity levels
- Identifying and avoiding specific triggers for your child
By removing asthma triggers air quality can be improved, while reducing symptoms in children and adults. Additionally, this step has been proven to decrease hospitalizations, emergency department visits, and the use of rescue medicine.
The Importance of Asthma Education
According to the National Asthma Education and Prevention Program-Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, personalized one-on-one education from the patient's primary clinician proves highly effective. Studies indicate that such education reduces asthma exacerbations and hospitalizations.
Parents and caregivers should understand:
- How to recognize early warning signs of worsening asthma
- Proper inhaler technique and medication administration
- The difference between controller and rescue medications
- When to seek emergency care
- How to use an asthma action plan
Creating an Asthma Action Plan
An asthma action plan is a personalized guide that outlines daily management strategies and emergency responses. Assessment of asthma self-management education found that 50.8% of children with asthma received an asthma action plan, but every child with asthma should have one.
The plan typically includes three zones:
Green Zone (Doing Well): Lists daily medications and indicates good asthma control
Yellow Zone (Getting Worse): Identifies warning signs and outlines steps to take when symptoms worsen
Red Zone (Medical Alert): Details emergency symptoms and when to seek immediate medical care
Monitoring and Regular Follow-Up
Regular monitoring is essential for maintaining asthma control. The cornerstone of diagnostic evaluation is spirometry, which aids in identifying chest wall, respiratory muscle defects, and respiratory muscle weakness. This technique also assesses airflow limitation and excludes alternative diagnoses.Healthcare providers should assess asthma control at every visit, tracking:
- Symptom frequency and severity
- Nighttime awakenings
- Use of rescue medications
- Ability to participate in normal activities
- Lung function measurements (when age-appropriate)
School-Based Asthma Management
Since children spend significant time at school, proper school-based management is critical. Schools should:
- Have trained staff who understand asthma management
- Provide quick access to rescue medications
- Implement asthma action plans
- Reduce environmental triggers in classrooms
- Support physical activity with appropriate precautions
The CDC EXHALE Approach
In 2018, NACP formally characterized this multistrategy approach in a technical package known as EXHALE, designed to inform decision-making for communities, organizations, and states as well as facilitate multisector collaborations that would build on asthma-related public health and health care collaboration in CDC's 6|18 initiative. EXHALE is a set of 6 strategies used to facilitate asthma control in children and adults.
The EXHALE strategies include:
- Education on asthma self-management
- EXposure reduction (environmental triggers)
- Home visits for trigger reduction and asthma education
- Achieving guidelines-based medical care
- Linkages to community resources
- Environmental policies and systems change
Addressing Health Disparities
An estimated 8% of children had asthma in 2020, and it continues to have a significant impact in the lives of many kids. However, the burden is not equally distributed. Children from low-income families and certain racial and ethnic groups experience higher rates of asthma-related hospitalizations and emergency visits.
Successful asthma management requires addressing these disparities through:
- Culturally appropriate education materials
- Community-based intervention programs
- Access to affordable medications
- Support services for families
- Coordination between healthcare providers and community resources
Key Takeaways for Parents
Work closely with your healthcare team to develop a personalized asthma management plan Educate yourself and your child about asthma triggers and early warning signs Ensure proper medication technique and adherence to prescribed treatments Create an asthma-friendly environment by reducing triggers at home and school Monitor symptoms regularly and keep scheduled follow-up appointments Maintain an updated asthma action plan and share it with all caregivers Advocate for your child in school settings and other environments
Conclusion
Managing childhood asthma requires a comprehensive, multifaceted approach involving proper medication use, environmental control, education, and regular monitoring. Treatment strategies focus on patient and caregiver education, regular symptom monitoring, and the implementation of stepwise tailored medication regimens based on symptom severity.
With the latest evidence-based guidelines and strategies, most children with asthma can achieve excellent control, allowing them to participate fully in school, sports, and all childhood activities. The key is partnering with healthcare providers, staying informed about the latest management strategies, and remaining proactive in your child's care.
Remember, asthma is a manageable condition. With proper care strategies and consistent implementation, your child can thrive and enjoy a full, active childhood.
References
Centers for Disease Control and Prevention. (2024). Controlling Childhood Asthma and Reducing Emergencies | NACP. https://www.cdc.gov/national-asthma-control-program/php/about/ccare.htmlNational Center for Biotechnology Information. (2024). Pediatric Asthma - StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK551631/
Pediatrics Nationwide. (2023). Understanding and Implementing the Latest Recommendations for Asthma Management. https://pediatricsnationwide.org/2023/05/26/understanding-and-implementing-the-latest-recommendations-for-asthma-management/
American Lung Association. Controlling Childhood Asthma and Reducing Emergencies Initiative. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/health-professionals-educators/exhale
Mayo Clinic. (2025). Childhood asthma - Diagnosis & treatment. https://www.mayoclinic.org/diseases-conditions/childhood-asthma/diagnosis-treatment/drc-20351513