Long-term control of pediatric asthma: prevention, phenotypes, and precision management in children
Keywords:
pediatric asthma, prevention, management, biologics, SMART, environment, phenotypes, exacerbationsAbstract
Pediatric asthma is one of the most prevalent chronic diseases in childhood worldwide and a leading cause of emergency visits, hospitalizations, and school absenteeism. Asthma often begins early in life, is driven by heterogeneous endotypes, and is strongly shaped by environmental and social determinants. This narrative review summarizes contemporary evidence on the epidemiology, risk factors, prevention, and stepwise management of pediatric asthma, with a focus on guideline-based pharmacotherapy, environmental control, self‑management support, and emerging biologic therapies. Recent global data show a substantial, but uneven, burden of asthma among children and adolescents, with rising prevalence in some low‑ and middle‑income countries and persistent inequities in high‑income settings. Biologic agents targeting type 2 inflammation and single maintenance and reliever therapy (SMART) with inhaled corticosteroid–formoterol have transformed care for severe and moderate disease, respectively. At the same time, school‑ and community‑based, multimodal interventions addressing environmental exposures and social risk factors can meaningfully reduce exacerbations and acute care use. Integrating phenotype‑directed pharmacologic strategies with tailored environmental and social interventions, and robust asthma action plans, offers the greatest potential to modify the trajectory of pediatric asthma across the life course.
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