Findings from a recent study can help you choose with your doctor the best option for managing your child’s mild persistent asthma. This study compared two different approaches to using controller inhalers to treat asthma.
The findings were part of a study funded by the Patient-Centered Outcomes Research Institute (PCORI).
What is mild persistent asthma?
Asthma is a disease that can cause inflammation in your airways and make it hard to breathe. Asthma can range from mild to severe, depending on how often symptoms occur. Children with mild persistent asthma usually have symptoms two or more days per week, but not every day. Some may experience an occasional asthma attack, but not frequently. These children may experience symptoms less often if their asthma is well-controlled. Children with mild persistent asthma use two types of asthma medications:
- an inhaler for quick relief of symptoms. These inhalers are often your albuterol medication.
- a controller inhaler to prevent symptoms. They also can reduce inflammation. Controller inhalers typically contain corticosteroids. They are often referred to as inhaled corticosteroids, or ICS.
What treatment options for asthma were studied?
The study looked at two different approaches to using controller inhalers. One approach looked at children using the controller inhaler every day. This is what national asthma guidelines and likely your doctor recommend you do for asthma control. The other approach looked at using the controller inhaler as-needed with albuterol when you have symptoms. Researchers wanted to see if using controller medications as-needed worked as well as using the controller inhaler every day.
The first approach, using daily controller medication, is how asthma has been treated for 30+ years. The doctor prescribes a daily controller medicine (inhaled corticosteroids) to take every day. This helps keep asthma symptoms under control. It’s used even when the child has no apparent symptoms.
The second approach, using controller medications as-needed, is new. It gives the patient and family a choice. This allows the child and their caregiver to add in the controller medication during times when their symptoms are worse. The controller medication is not used every day. It should be taken with the quick-relief albuterol at the same time when you experience asthma symptoms.
Daily or as-needed? Infographic Transcript
Daily or as-needed? - Managing Mild Asthma in Children Ages 6 and Older
Sumino, Kaharu et al. “Comparing Two Ways to Manage Asthma in African American Children—The ASIST Study.” (2020).
Findings from a recent study can help you work with your doctor to choose the best option for managing your child’s mild persistent asthma.
Children and teens use different kinds of inhalers to help control their asthma symptoms
• A quick-relief inhaler is used when symptoms suddenly get worse.
• Usually contains a medicine called albuterol.
• A controller inhaler helps prevent asthma symptoms.
• Usually contains corticosteroids.
• Acts to treat inflammation in the airway from asthma.
• This inhaler can keep daily • symptoms from getting worse.
Different ways to use a controller inhaler
Daily (traditional way)
• Use controller inhaler everyday.
• Does not matter if asthma symptoms are present or not.
• This method has been recommended for over 30 years.
As-Needed (new way)
• Take the controller WITH the quick-relief inhaler when used to relieve asthma symptoms.
• Children using this approach tend to use less corticosteroid medicine overall.
Does using a control inhaler as-needed work for children and teens with mild persistent asthma?
• Daily and as-needed treatment options had the same effectiveness in…
• Improving asthma control
• Asthma attacks and/or hospital visits
• Lung function
• Quality of life
• The as-needed approach required only 25% of the medicine to achieve the same control as those taking a daily fixed dose.
• Parents and their children who use the as-needed approach feel they are taking charge of their asthma management.
Which approach – daily or as-needed – is right for your child?
Shared Decision-Making with your child’s doctor...
• Decide together which treatment approach is best for your child based on asthma control, lifestyle and healthcare needs.
• Develop an Asthma Action Plan.
Questions to ask…
• Is the as-needed approach appropriate for my child?
• Does my child have symptoms or triggers that require the daily approach?
• How can I tell if the as-needed approach is working well?
What to consider when choosing which option works best for you and your child
• Daily approach may work well when parents and children can visit doctor regularly. (As-needed approach does not rely on regular doctor visits.)
• As-needed approach may work well when parent and child are able to identify asthma symptoms and treat flares when they happen.
• As-needed approach may work well for families who want to use less asthma medication.
• Make sure the treatment option you choose is included in your child’s Asthma Action Plan.
To learn more about these findings, visit: allergyasthma.org/asist/
What are key findings of this study for parents and caregivers?
The study found that using the controller medication as-needed, rather than daily, worked the same as daily use for children and teens with mild persistent asthma. There was no increase in asthma flares, decrease in lung functioning, or reduced quality of life. Children who used a controller medication as-needed used a lot less corticosteroid medicine (25%) overall compared to those who took it daily.
You may want to talk with your doctor about which treatment approach—daily or as needed—would work best for your child’s asthma. Your doctor can help you create an Asthma Action Plan that best fits your lifestyle and needs. To learn more about this study, and to get a list questions you can ask your child’s doctor about asthma treatment options, visit:
What are the key findings of this study for clinicians?
The traditional approach to prescribing ICS is for daily use. This research study compared two different treatment options: daily use of ICS (standard of care) as compared to as-needed use of ICS (beclomethasone taken with albuterol) for children with mild persistent asthma. This study adds to evidence that symptom-based adjustment of medication works as well as provider-based adjustment for treating children and teens with mild persistent asthma.
The control group used daily ICS. The intervention group were prescribed an ICS and directed to take two puffs of the ICS every time they took their albuterol for symptoms.
The study found no significant difference in asthma control between the daily ICS group and the as-needed ICS group. To measure asthma control, they looked at asthma flares, lung function tests, and quality of life. Patients taking ICS as-needed required a quarter of the dose of ICS compared to the daily group.
This treatment option would allow children and parents to take more control over their asthma management.
When deciding which approach is best, it is important to educate parents and their children on asthma symptoms. Then explore what works best for the child. If the as-needed approach is chosen, then educate on when to use ICS and the importance of follow-up. The Asthma Action Plan should also reflect this approach.
The study findings are consistent with the current National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute (NHLBI) clinical guidelines updated in 2020. The findings are also consistent with Global Initiative for Asthma (GINA) guidelines in 2021.
Treating Mild Asthma in Children Infographic Transcript
Inhaled Corticosteroids (ICS) control airway inflammation and relieve symptoms.
Daily fixed dose: Use control inhaler every day.
As-needed: Use control inhaler (2 puffs) only when experiencing symptoms.
Which treatment option is best fit for your patient?
Researchers at the Patient-Centered Outcomes Research Institute (PCORI) studied each option in African-American children and teens with mild, persistent asthma.
1. The daily fixed dose and as-needed treatment options had the same effectiveness in...
- Asthma control
- Asthma attacks
- Lung function
- Quality of life
2. Patients using ICS as-needed used significantly less medication than those on a daily fixed dose.
3. Patients and families using ICS as-needed felt they were taking charge of their asthma management.
Asthma Management Guidelines
As-needed ICS is a treatment option for children ages 12 and older with mild persistent asthma. It is consistent with asthma guidelines:
- National Asthma Education and Prevention Program (NAEPP) – 2020 update
- Global Initiative for Asthma (GINA) – 2021 update
Talking Points with Parents, Caregivers and Children/Teens
Questions for your patients to help determine which treatment option is best:
- Which best fits your asthma control? Lifestyle?
- Are you able to recognize when asthma is worsening?
- How often can you check in with your doctor to assess asthma control?
- Do you have concerns (side effects, cost) with taking ICS daily?
- Do you need additional asthma education or coaching?
- Decide together with your patient which treatment approach is the best fit.
- Develop an Asthma Action Plan.
For more information about the study findings, and topics for discussion with parents and children with asthma, visit: