Patient discussions

Education that includes both children and parents is a fundamental component of paediatric asthma management.[272] Children and parents should receive a written asthma management plan, age-appropriate, and individualised instruction on symptom and/or lung function monitoring, and training on optimal inhaler technique and medication use.​[273] Asthma and Lung UK:​ Asthma Opens in new window​​​ [ Cochrane Clinical Answers logo ] ​​​​ Parent/carer goals for therapy should be explored.[1]​

Supported self-management

The documented asthma action plan should provide information to help patients or parents recognise and respond appropriately to worsening asthma.​[1][8] Asthma+Lung UK: Health advice resources Opens in new window​​​​​ Plans targeting symptom-based management, not peak expiratory flow, have been shown to reduce exacerbation rates.[274][275][276]​​​​​ Regular professional support for self-management is associated with greatest reduction in healthcare use and the greatest gains in quality of life, especially among patients with mild to moderate symptoms.[277]

Several other strategies have also been shown to improve adherence and specific outcomes:

  • Digital interventions (e.g., text message or electronic monitoring): improve treatment adherence, reduce exacerbations, and improve asthma control in children.[278] [ Cochrane Clinical Answers logo ]  

  • Outcomes are better where these are supported with motivational interviewing and feedback.[278]

  • Use of an 'at-risk' asthma registry in primary care: reduces hospitalisations and increases prescriptions of recommended preventative therapies without increasing costs; does not affect exacerbation frequency.[279]

  • Home‐based educational interventions for asthma: limited evidence indicates that intensive home-based education may improve quality of life compared with control and may reduce the odds of hospitalisation compared to less‐intensive educational intervention.[280]

  • School-based interventions and community health worker visits: likely to be beneficial for improving asthma control and reducing asthma exacerbations.[281][282] [ Cochrane Clinical Answers logo ] ​​​​ Such strategies can also improve the delivery of guideline-based care to minority, historically marginalised, and under-resourced communities.[283] Parental involvement is important for positive outcomes.[284]

  • Community interventions (e.g., care coordination, smoke-free legislation, traffic reduction, and home- and community-based health services): significantly reduce emergency department visits and hospitalisations in children with asthma through self-efficacy, trigger control, and improved healthcare access.[285][286]​​

  • Culture-specific education programmes: healthcare workers who are of the same ethnic group as the patient can address cultural barriers.[287]

  • Educational programmes and cognitive behavioural therapy: children with asthma and symptoms of anxiety/depression may benefit.[288]​​[289]​ Evidence is limited.[290][291]​​​​

  • Educating school staff: improves adherence to asthma policies, but does not affect outcomes for children with asthma.[292] [ Cochrane Clinical Answers logo ]

Close partnerships with stakeholders and the removal of systemic barriers are essential for the development of effective interventions to optimise adherence and reduce hospital exacerbations.[286][293][294]​​​​​​​​​ 

Older children and adolescents are encouraged to take increasing responsibility for their own self-management, which can be facilitated by early consideration of the need to transition from pediatric to adult care.[295] Children and adolescents in this transitional phase represent a distinct patient subgroup with their own needs, and they may benefit from appointment time without their main caregiver to discuss more sensitive issues (e.g., smoking or mental health).[296]

Inhaler technique and choice

Initial inhaler choice is primarily based on patient preference and demonstration of correct technique with the selected device.[1][8]​​​​ Where possible, prescribe devices with integrated dose counters and prescribe the same type of inhaler device when more than one is prescribed.[297]​ Children are usually prescribed a spacer for use with a metered dose inhaler, but older children with good co-ordination may be able to use standard devices. Asthma + Lung UK: how to use your inhaler Opens in new window

Check inhaler technique at every opportunity. Ensure the patient is using medications and delivery devices correctly: a better technique is associated with better asthma outcomes.​​​​​

Consider patient and parental concerns about inhaler choice, including environmental issues.[168] Asthma+Lung UK (NHS): inhaler choices Opens in new window BTS/NICE/SIGN: asthma inhalers and climate change Opens in new window​​​ Addressing poorly controlled asthma, particularly curbing high short-acting beta-agonist (SABA) use, has the most significant effect on asthma care-related carbon emissions.[298]

Do not swap inhalers without proper discussion and follow-up.[299]

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