Pediatric asthma

Also known as: childhood asthma

Also relevant to Respiratory

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United StatesAAP

Current

2020 Focused Updates to the Asthma Management Guidelines

National Heart, Lung, and Blood Institute (NHLBI/NIH), National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group · 2020 · 2020 focused update to EPR-3 (ages 0-4 stepwise table updated February 2021)

The current US federal asthma guidance, updating selected topics from the 2007 EPR-3 guidelines rather than replacing them wholesale. It includes age-banded stepwise treatment tables covering children, and NHLBI publishes a clinician's guide and at-a-glance summary alongside the full report.

Developed by the NAEPP Coordinating Committee Expert Panel Working Group under NHLBI and released in December 2020. source
NHLBI notes the stepwise approach table for ages 0-4 years was updated in February 2021. source

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EuropeESPGHAN/EAP

Current

Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN)

British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) · 2024 · NG245

A joint BTS/NICE/SIGN guideline published in November 2024 covering diagnosis, monitoring and long-term management of asthma, with separate recommendation streams for children under 5, children aged 5-11 and people aged 12 and over. It does not cover acute attacks or severe asthma.

Replaces NICE guideline NG80 (2017) and parts of the BTS/SIGN guideline SIGN 158 (2019), along with several NICE technology appraisals and diagnostics guidance. source
Recommendations are structured by age band, including children under 5 and children aged 5 to 11 years. source

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US vs EU key differences

Version currency differs: the US guidance is a 2020 focused update to the 2007 NHLBI expert panel report, while the joint BTS/NICE/SIGN guideline is a 2024 full rewrite. source
Diagnostic testing differs: NICE 2024 makes FeNO a first-line objective test with an explicit cut-off (35 ppb or more diagnoses asthma in children aged 5-16), whereas the NHLBI 2020 update only conditionally adds FeNO as an adjunct for monitoring and adjusting therapy in patients aged 5 and over. source
NICE 2024 states that short-acting beta2 agonists should not be prescribed to anyone with asthma without a concomitant inhaled corticosteroid, a blanket prohibition the NHLBI 2020 stepwise tables do not make. source
Both converge on ICS-formoterol reliever strategies: NHLBI 2020 makes SMART the preferred option at moderate-to-severe steps from age 4 upward, and NICE 2024 makes MART the preferred step-up for children aged 5-11 and as-needed ICS/formoterol (AIR) the entry treatment from age 12. source

What changed recently

EUNG80 (2017) and BTS/SIGN 158 (2019) → NG2452024-11-27
The first joint BTS/NICE/SIGN guideline replaced NICE NG80 and parts of BTS/SIGN 158, ending short-acting beta-agonist monotherapy: every patient with asthma should receive inhaled corticosteroid-containing treatment. For those aged 12 and over the preferred pathway is now anti-inflammatory reliever or MART with combination ICS-formoterol, and the diagnostic pathway was reworked around objective testing.
source ↗
USEPR-3 (2007) → 2020 focused update to EPR-32020-12-01
Rather than rewriting EPR-3, the 2020 report issued GRADE-based updates in six priority areas: intermittent inhaled corticosteroids and single maintenance-and-reliever ICS-formoterol therapy, add-on long-acting muscarinic antagonists, fractional exhaled nitric oxide testing, indoor allergen reduction, subcutaneous and sublingual immunotherapy, and bronchial thermoplasty. FeNO is newly recommended as an adjunct when the asthma diagnosis or the choice of controller is uncertain in patients aged 5 and over.
source ↗curation confidence 90%

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