ASTHMA TREATMENT IN CHILDREN: RECENT EVIDENCE AND CHALLENGES IN PEDIATRIC PRACTICE

Abstract

Asthma is the most common chronic respiratory disease in childhood, and its inadequate management results in significant morbidity and preventable deaths. The current therapeutic paradigm, consolidated by global guidelines such as the Global Initiative for Asthma (GINA), emphasizes the control of chronic airway inflammation as a fundamental pillar. This review synthesizes recent evidence on the treatment of pediatric asthma, highlighting a crucial shift: the eradication of short-acting bronchodilator (SABA) monotherapy for most children, recommending the use of inhaled corticosteroids (ICS) from the early stages to reduce the risk of severe exacerbations. Treatment is stratified by levels of control, adopting a stepwise approach that begins with ICS and progresses with the addition of long-acting bronchodilators (LABAs) and, in severe cases, biological therapies targeting the inflammatory phenotype. A holistic approach, integrating education, personalized action plans, and the management of risk factors such as obesity and allergen exposure, is essential for therapeutic success. Pulmonary rehabilitation, including breathing exercises and physical activity, is emerging as an important non-pharmacological adjunctive therapy. Persistent challenges in the diagnosis, treatment adherence, and management of severe asthma continue to limit clinical outcomes, requiring an ongoing partnership between healthcare professionals, patients, and their families.