What guidelines should I follow for the assessment and management of asthma in children, including when to refer to a specialist?

Follow the guidelines outlined in the NICE, BTS, and SIGN documents for the assessment and management of asthma in children ¹.

For children under 5 years with suspected asthma, consider an 8 to 12-week trial of twice-daily paediatric low-dose inhaled corticosteroid (ICS) as maintenance therapy, with a short-acting beta-2 agonist (SABA) for reliever therapy ¹.

If symptoms do not resolve during this trial, check inhaler technique and adherence, review environmental factors, and consider alternative diagnoses; if no explanation is found, refer the child to a specialist in asthma care ¹.

In children under 5, if symptoms are uncontrolled on a paediatric moderate dose of ICS, consider adding a leukotriene receptor antagonist (LTRA) for 8 to 12 weeks, and if ineffective or not tolerated, refer to a specialist ¹.

For children aged 5 to 11, consider paediatric low-dose MART if asthma is not controlled on low-dose ICS plus SABA, and escalate to moderate-dose MART if needed; if control remains inadequate, refer to a specialist ¹.

In children aged 12 and over, initial treatment includes a low-dose ICS/LABA inhaler plus SABA, with escalation to moderate-dose if necessary, and referral if asthma remains uncontrolled on these regimens ¹.

Referral to a specialist is indicated if there is diagnostic uncertainty, persistent symptoms despite optimized treatment for 3–6 months, severe or difficult-to-treat asthma, or a history of near-fatal exacerbation ¹.

Children with severe or life-threatening features, or those with worsening symptoms despite initial bronchodilator treatment, should be considered for hospital admission ².