Clinical meaning
Pediatric asthma management adapts adult step therapy principles to age-specific physiology and device capabilities. For children 0-5 years, ICS via MDI with valved holding chamber (VHC) and face mask is the standard delivery system. Nebulizers are reserved for severe exacerbations or children who cannot use VHC. Step therapy for ages 0-5: Step 1 = PRN SABA, Step 2 = low-dose ICS daily, Step 3 = double ICS dose or add LTRA, Step 4 = refer to specialist. For children 6-11 years, spirometry guides therapy, and dry powder inhalers (DPI) can be used if inspiratory flow is adequate (typically >= 30 L/min). LABA can be added at Step 3 (always with ICS, never alone). Exercise-induced bronchoconstriction is managed with SABA 15-30 minutes before exercise or daily LTRA. Biologic therapy (omalizumab approved >= 6 years) is considered at Step 5 for severe allergic asthma uncontrolled despite adherent high-dose ICS-LABA therapy.
Diagnosis & workup
Diagnostics & workup: - Spirometry pre and post bronchodilator in children >= 6 years at diagnosis and step changes - Inhaler technique assessment at every visit (standardized checklist) - Asthma control assessment using C-ACT (children 4-11) or ACT (>= 12) - Peak flow monitoring for school-age children with moderate-severe asthma - Allergy testing to identify modifiable environmental triggers - Growth velocity monitoring every 6-12 months on ICS