Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity as measured by school absences, emergency department visits, and hospitalizations. Multiple factors play a role in the development, treatment and prevention of childhood asthma including racial/ethnic and socioeconomic disparities, both the home and school environments, and medication use. The goals of this review are to summarize these aspects of asthma in school-aged children and to present an updated review of medications as it relates to treatment strategies that will help in the care of these children. We conclude that phenotypic heterogeneity and appropriate environmental assessments and interventions are important considerations in the management of childhood asthma.
Asthma is the most common noncommunicable childhood disease affecting approximately 14% of children globally and 8.6% of children in the United States, with a rising prevalence worldwide.1, 2 Furthermore, asthma accounts for more than 14 million missed school days per year3 and costs billions of dollars in health care utilization.4 Despite advancements in asthma management and the availability of effective medications, harmful environmental exposures and health disparities continue to exist.5
Children of minority groups are more likely to have a higher prevalence of asthma, frequent emergency room visits, and are at risk of having fragmented health care as a result of economic and noneconomic factors.5Moreover, environmental exposures are known to play a major role in the pathogenesis of asthma and its morbidity.6 Aeroallergen and airborne pollutant exposures in urban home and school environments have been implicated in worsening asthma symptoms in children.7 A Cochrane meta-analysis estimated that environmental control practices reduced the risk of current asthma by approximately 30% to 50% in children.8 Therefore, it is important that children with asthma take all the essential actions recommended to reduce their exposure to indoor environmental asthma triggers.9
This review article will focus on current evidence supporting the clinical management of asthma among school-aged children in the context of existing racial/ethnic and socioeconomic disparities, environmental exposures, current guidelines-based treatments, and promising novel therapeutics.