Abstract / Summary
Asthma remains the commonest chronic pediatric respiratory disease and a major cause of childhood morbidity worldwide. Recent advances in pediatric asthma management shift the focus from symptom relief alone towards early control of airway inflammation, exacerbation prevention, and personalizing biomarkers to target biologics. This review highlights the growing role of anti-inflammatory reliever [AIR] therapy and maintenance-and-reliever therapy [MART], both of which incorporate inhaled corticosteroids [ICS] with bronchodilator treatment to reduce reliance on short-acting β2-agonists [SABA]. Pediatric clinical trials demonstrate that strategies including AIR only and MART, compared to SABA reliever, reduce acute asthma attack burden in some disease subgroups while further large trials are underway. For severe pediatric asthma, advances in understanding type 2 airway inflammation have led to the introduction of biologics targeting key inflammatory pathways, including IgE, interleukin (IL)-5, IL-5 receptor, IL-4/IL-13 signaling, and thymic stromal lymphopoietin. Adult trials have shown reductions in asthma attacks with all currently licensed biologics. Although pediatric evidence remains more limited than in adults, we summarize the current evidence of efficacy in childhood severe asthma. Biomarker-guided selection using blood eosinophils, fractional exhaled nitric oxide, and serum IgE is increasingly important, yet optimal pediatric biomarkers of response remain uncertain. Current challenges include gaps in child-specific biomarker validation and uncertainty regarding treatment duration and discontinuation strategies. Overall, contemporary pediatric asthma management is moving towards precision medicine, integrating anti-inflammatory reliever strategies and targeted biologics to improve disease control, minimize exacerbations, and preserve long-term lung health.