What's new in paediatric asthma?

It is well documented that asthma outcomes for children and young people in the UK are amongst the worst in Europe and in high-income countries worldwide. Several reports in the last 10 years have evaluated the reasons for the poor outcomes, with a high degree of concordance between the report findings. In this review, we summarise the key findings of these reports and how they are being addressed by new treatment strategies in updated guidance published annually by the Global Initiative for Asthma (GINA) and the latest update of the joint British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) Asthma guideline. We discuss the importance of an early and accurate asthma diagnosis; the problem of poor recognition of asthma severity and the dangers of short acting beta agonists (SABA) overuse and inhaled corticosteroid (ICS) underuse. We summarise the evidence for anti-inflammatory reliever (AIR) strategy and maintenance and reliever therapy (MART) which are now advocated in all new asthma guidance due to compelling evidence showing their positive impact on most treatment outcome measures. Finally, we highlight changes to Salbutamol weaning guidance in children discharged from hospital following an acute asthma exacerbation.