NP Board Prep: Pediatric Asthma Treatment Guidelines

Are you looking for a good review of pediatric asthma treatment guidelines? Then be sure to watch this video by Ashton Glover, DNP, FNP-C, ENP-C, in which she reviews how to treat pediatric asthma in children ages 6-11. It gives you a great overview of the treatment guidelines for kids that age!

Here’s a quick review of what Ashton covers in the video.

What is asthma?

Definition: Asthma is a “chronic respiratory condition that causes reversible airway obstruction.”

The key word in this definition is reversible. The inflammation/swelling and mucus produced during an asthma attack respond to treatment.

Asthma symptoms can come and go, and common triggers include: 

✅ Allergens
✅ Cold air
✅ Exercises
✅ Stress 

In the video, Ashton also reveals what the number one symptom of asthma in kids ages 6-11 is. Do you know the answer? 

Answer: it’s coughing, especially at night. Chest tightness, wheezing, and shortness of breath are also common symptoms, but sometimes they only happen when a child is having an asthma attack. 

How do you diagnose & treat pediatric asthma?

The gold standard when it comes to diagnosing pediatric asthma is spirometry, the key element of which is FEV1. This is the forced expiratory volume in one second, which is a measure of how much air the child can forcefully exhale in a single second.

Typically, you’ll measure a child’s FEV1 before and after they’re treated with a bronchodilator. If the child’s FEV1 increases after they’ve been treated with a bronchodilator, that points to a diagnosis of asthma.

That said, the Global Initiative for Asthma (GINA) guidelines have shifted away from relying solely on spirometry numbers to diagnose a child with asthma. Now, symptom control and quality of life are also considered important factors to consider before making a diagnosis. 

2024 GINA Pediatric Asthma Treatment Guidelines

The new guidelines use a stepwise approach to treat asthma, based on how often a child has symptoms and how well their asthma is controlled. There are five steps, progressing in symptom severity as we go from step one to step five.

The treatment guidelines for each step are as follows:

Step 1

These patients have mild, infrequent symptoms less than twice a month.

In these cases, use a low-dose inhale corticosteroid (ICS) only when a short-acting beta-agonist (SABA) is taken. This is as needed, and the child doesn’t need daily controller therapy.

Step 2

Patients in step 2 have symptoms twice a month (or more), but less than daily.

For these patients, start daily low dose ICS as a maintenance therapy. They will still need a SABA for times when they need quick relief.

Step 3

These patients have symptoms on most days, and they may wake up with asthma once a week or more.

These patients will receive daily maintenance therapy, which can be done in different ways:

⭐ Increase the ICS to a medium dose with a SABA as needed.
⭐ Use a low-dose ICS long-acting beta-agonist (LABA) combination with a SABA as needed.
⭐ Switch to maintenance and reliever therapy using a very low-dose ICS formoterol. ICS formoterol is the only LABA that can be used for both maintenance and as a reliever.

Step 4

These children have daily symptoms that wake them up at night.

They need a daily medium-dose ICS (formoterol). At this stage, you should strongly consider referring to pulmonology.

Step 5

These are children who were in step 4 and their symptoms continue to get worse. At this stage, they must be referred to pulmonology.

The bottom line is, no matter if it’s step 1-5, the child ALWAYS needs medication that can be used for quick symptom relief!
⭐ For children in steps 1- 2, you can use a SABA.
⭐ For children in steps 3-4, it’s better to use a low-dose LABA+ICS (formoterol).

You should never use a LABA alone when treating asthma! All children need something for quick symptom relief.

So there’s an overview of current pediatric asthma treatment guidelines. But we’ve barely scratched the surface! Be sure to watch the video to get a more comprehensive review. And subscribe to the SMNP YouTube channel, where you’ll find lots of great tips on how to get through NP school, crush your boards, and kickstart your NP career!

And for more NP learning, check out these other posts:

• Understanding Basic COPD Treatment Guidelines
• NP Learning: Pediatric Musculoskeletal Conditions
• NP Learning Professional Role: Levels of Evidence