Primary prevention

Preventing future asthma exacerbations and minimising emergency department visits or hospitalisations are key goals of asthma care that can be achieved through appropriate treatment and adherence.[7][50]​​​ International guidelines from the Global Initiative for Asthma suggest the following steps for patients who have poor symptom control and/or exacerbations despite treatment:[7]

  • Check the patient’s inhaler technique and show them the correct technique

  • Discuss adherence to treatment and any barriers

  • Check that the patient has a written, personalised asthma action plan

  • Confirm the diagnosis of asthma, if there is any doubt

  • Remove or mitigate any risk factors or triggers, if possible

  • Manage comorbidities

  • Consider stepping up long-term treatment

  • Consider specialist referral.

Asthma management plans help parents and children to recognise when asthma is deteriorating and how to respond appropriately: for example, increasing usual reliever and maintenance treatment, starting a short course of oral corticosteroids, and determining when to seek medical help.[7] School‐based asthma self‐management interventions, engagement in the decision-making process, and even the use of digital interventions (e.g., trackers or reminders) may help.[51][52][53]​​​​​[54]

Tailored allergen mitigation strategies may also be beneficial in individuals who are exposed to relevant allergens (e.g., dust mites or cat dander) and have a history of associated symptoms or positive allergy testing (e.g., skin testing or a specific IgE).[55] Multicomponent allergen interventions are recommended based on experience that single-component interventions often do not work.[55][56] A suitable asthma management plan that is properly implemented can remove the need to avoid known triggers (e.g., allergens or poor air quality), although many children will continue to have viral-induced exacerbations despite otherwise good control.[7]

Refer to the topic Asthma in children for more information about how to maintain control of asthma.

Secondary prevention

Patients who continue to experience asthma exacerbations despite treatment may need to have their treatment stepped up. Before this happens, clinicians need to check patients' adherence to treatment and inhaler technique, make sure patients have a written asthma action plan, confirm the diagnosis of asthma (if there is any doubt), consider specialist referral, and review any persistent allergen exposure, triggers and comorbidities.[7]​ See Asthma in children.

Viral infections are a significant trigger for acute asthma exacerbations and may be prevented by vaccination.[7]​​ However, schedules vary by location; consult local guidance for recommendations. UKHSA: complete routine immunisation schedule Opens in new window CDC: child and adolescent immunization schedule by age Opens in new window​​

While influenza vaccination is recommended in many countries for children with asthma, studies have failed to demonstrate a beneficial effect on asthma exacerbation rates or lung function decline.[161] However, data suggest it is well tolerated and does not precipitate exacerbation.[161][162]​​ There is insufficient evidence to support a beneficial role for pneumococcal vaccination in children with asthma.[163] 

Improving control of related comorbidities, such as allergic rhinitis, may be beneficial to asthma control.[164] Relapse rates after discharge are higher in those with atopy.[165]​ Interventions to decrease environmental tobacco smoke exposure have been shown to benefit children at high risk of asthma exacerbations.[166][167]​ High efficiency particulate air (HEPA) filters reduce indoor air pollution and aeroallergens, improving asthma symptoms.[18]​ Public education campaigns appear to have positive effects on use or intention to use electronic nicotine delivery products.[29]

One Cochrane review showed that oral corticosteroids can reduce relapse rates, although this was based primarily on randomised controlled trials conducted in adults.[168] High-dose inhaled corticosteroid therapy has shown similar efficacy to oral corticosteroids, but is not as cost effective.[50]

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