CHILDHOOD ASTHMA: CURRENT THERAPEUTIC STRATEGIES AND ADVANCES IN DISEASE CONTROL

Abstract

Asthma is the most common chronic respiratory disease in childhood, characterized by airway inflammation and variable symptoms such as wheezing and cough. Diagnosis in children is challenging, especially in children under 5 years of age, where diagnosis is based on symptom pattern and response to a therapeutic trial, while in older children (≥6 years) ideally, diagnosis should be confirmed by spirometry. This review addresses current therapeutic strategies, highlighting the fundamental change in the GINA guidelines that eliminated short-acting beta-2 agonist (SABA) monotherapy due to the increased risk of severe exacerbations. The current approach emphasizes the use of inhaled corticosteroids (ICS) at all levels to control underlying inflammation. Escalated treatment for children aged 6 to 11 years prioritizes low-dose ICS (daily or as-needed with SABA), while for adolescents (≥12 years), the preferred therapy is the as-needed ICS-formoterol combination (AIR strategy). For severe asthma, referral to biologic therapies targeting Type 2 inflammation (anti-IgE, anti-IL-5, anti-IL-4/13) is indicated. Holistic management, including education, a Personalized Action Plan (PAPA), and management of triggers and comorbidities, is essential for successful treatment.