Management of pediatric asthma

The principles of asthma management in preschool- and school-age children have evolved substantially over the past two decades to the current approach that is guided by the goals of the attainment and maintenance of asthma control (see Chapter 16). In contrast to asthma severity, which defines the intrinsic intensity of asthma as assessed without the use of a controller therapy, asthma control reflects the degree to which the signs and symptoms of asthma are minimized. Thus, successful asthma management achieves multiple goals, including (1) the minimization of day-to-day asthma-related symptomatology (i.e., a reduction in the current impairment domain of asthma); (2) the reduction or elimination of asthma exacerbations; (3) the minimization of treatment-related side effects; and (4) ideally, the prevention of impaired lung growth and progressive decline in lung function (i.e., a reduction in the future risk domain of asthma).