Patient discussions

Education that includes both children and parents is a fundamental component of paediatric asthma management.[261] 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 (see Asthma and Lung UK:​ Asthma Opens in new window​ for patient information leaflets and template management plans).[262] [ Cochrane Clinical Answers logo ] ​ Parent/carer goals for therapy should be explored.[1]​

The documented asthma action plan should provide information to help patients or parents recognise and respond appropriately to worsening asthma. 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.[263][264][265]​​​ 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.[266]

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.[267] [ Cochrane Clinical Answers logo ]  

  • Outcomes are better where these are supported with motivational interviewing and feedback.[267]

  • 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.[268]

  • School-based interventions and community health worker visits: likely to be beneficial for improving asthma control and reducing asthma exacerbations.[269][270] [ Cochrane Clinical Answers logo ] ​​​​ Such strategies can also improve the delivery of guideline-based care to minority, historically marginalised, and under-resourced communities.[271] Parental involvement is important for positive outcomes.[272]

  • 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.[273][274]​​

  • Culture-specific education programmes: healthcare workers who are of the same ethnic group as the patient can address cultural barriers.[275]

  • Educational programmes and cognitive behavioural therapy: children with asthma and symptoms of anxiety/depression may benefit.[276]​​[277]​ Evidence is limited.[278][279]​​​​

  • Educating school staff: improves adherence to asthma policies, but does not affect outcomes for children with asthma.[280] [ Cochrane Clinical Answers logo ]

  • Environmental awareness: consider patient concerns about inhaler choice, specifically potential climate and economic benefit of delivering environmentally friendly respiratory care. Asthma+Lung UK (NHS): inhaler choices Opens in new window[281]

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.[274][282][283]​​​​​​​ 

Older children and adolescents are encouraged to take increasing responsibility for their own self-management, which should include early consideration of the need to transition from pediatric to adult care.[284] 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).[285]

In the UK, home nebulisers are not recommended for the relief of acute symptoms in children and adolescents without medical supervision by a respiratory specialist. This is because their use may mask deterioration and has led to fatal delays in treatment.[286]

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