This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
A study of more than 119,000 school-aged children compared the features of asthma at different ages. They found that:
- children aged 5 to 8 years were most at risk of having an asthma attack; this group was also most likely to have a delayed diagnosis
- children aged 9 years and over were more likely to have an attack if they were obese or sensitised to air particles (such as pollen)
- young people aged 12 to 16 years were most likely to be potentially under-treated; 1 in 5 used short-acting relievers only for 2 years.
The findings suggest that a child's age could inform treatment and management strategies, including advice on avoiding triggers and weight management.
More information on asthma can be found on the NHS website.
The issue: does a child’s age matter in the diagnosis and management of asthma?
More than 1 million children are being treated for asthma in the UK. The main treatments are short-acting relievers, which open airways and relieve asthma attacks; and long-acting preventers, which reduce inflammation in the lungs and prevent attacks.
Asthma is treated differently in children aged 1 to 5 compared with older children (such as the medications they can be offered). British Thoracic Society guidelines separate children aged 5 – 11 years from adolescents. However, until a recent update, National Institute for Health and Care Excellence (NICE) guidelines on the management of asthma were similar for younger (5 to 11 years) and older children (12 to 16 years). These age groups are considered separately in the updated version (in which children 12 years and older are included alongside adults).
Children’s growth and development could change the nature of asthma; a child’s age might also change how healthcare professionals help them manage their condition. Researchers therefore assessed the features of asthma, including its management and the risk of asthma attacks, in different age groups.
What’s new?
Researchers analysed the medical records (from primary and secondary care) of 119,611 children with asthma in England from 2004 to 2021. The study included 61,940 children aged 5 to 8 years; 32,316 aged 9 to 11 years; and 25,355 young people aged 12 to 16 years. They were followed up until they entered the next age group, or to the end of the study.
The study looked at how asthma and related conditions changed with age, including how likely participants were to have an asthma attack, or to have a delayed diagnosis (which the researchers defined as receiving asthma treatments before they received a diagnosis of asthma).
The study found that:
- 5 – 8 year olds were most likely to have an asthma attack (14% of these children had an attack in every whole year, compared to 7% among 12 – 16-year-olds)
- delayed diagnosis was most common in the youngest children
- young people aged 12 – 16 years were least likely to receive both long-acting preventers and short-acting relievers; 1 in 5 used short-acting relievers only for 2 years.
For children of all ages, being from a more deprived area and having a delayed diagnosis increased the risk of an asthma attack. Other risk factors varied with age. Compared with the other age groups:
- 5 – 8 year olds were more likely to have an asthma attack if they were male, had eczema or food and drug allergies
- those aged 9 and above were more likely to have an asthma attack if they were obese or allergic to air particles.
Why is this important?
The findings imply that childhood asthma could be diagnosed and managed more effectively. Better understanding of the impact of age could increase diagnoses and improve treatment choices for all. For example, younger children may need more help preventing asthma attacks.
Young people aged 12 to 16 may need a medicine review to ensure they are using both short-term relievers and long-term preventers. Some might also benefit from help with weight management as being overweight can increase the chance of an attack. Fewer than half (40%) of the children had a recorded body mass index (BMI) in this study; the researchers call for BMIs to be recorded routinely in asthma consultations.
In all ages, delayed diagnoses were linked with asthma attacks, but this was particularly common in the youngest group. Early diagnosis gives children access to annual reviews, an asthma management plan, and resources to learn about their condition.
British Thoracic Society guidelines on the management of asthma were updated in 2016. In this long-term study, most data were from before 2016, which could explain why some children received short-acting relievers only for extended periods. This is no longer recommended.
What’s next?
Updated NICE guidelines on the management of asthma now consider children aged 5 – 11 separately from those aged 12 and above.
British Thoracic Society guidelines issued in 2016 stated that people using short-term relievers regularly should also use long-term preventers. One approach to this is known as maintenance and reliever therapy (MART); this was recommended to adults with a history of asthma attacks on medium dose inhaled corticosteroids (long-acting preventers). It is now recommended as part of the treatment pathway in the 2024 NICE guidelines for children aged 5 and older. However, MART is not licenced for children under 12 years old, so this use would be off-label. The researchers call for trials to test its safety and effectiveness in younger children. They also call for trials to consider narrower age categories for children with asthma.
In further research among children with asthma, the same team found that less than half received the recommended asthma reviews, inhaler technique checks, and asthma management plans. Children who received all of these interventions had a reduced chance of an asthma exacerbation (reduction of approximately 30% in 12 months).
You may be interested to read
This is a summary of: Khalaf Z, and others. Influence of age on clinical characteristics, pharmacological management and exacerbations in children with asthma. Thorax 2024; 79: 112 – 119.
Information and support from Asthma and Lung UK.
Facts on childhood asthma from the Royal College of Paediatrics and Child Health.
A video on spotting the signs of childhood asthma.
Information on taking part in NIHR research on asthma.
Funding: This study was funded by the NIHR Imperial Biomedical Research Centre.
Conflicts of Interest: None declared.
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