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Health condition · Clinically reviewed

Child asthma, inhalers, spacers and a plan the school can follow.

The most common chronic disease of UK childhood - and one where a steady preventer, a spacer and a written plan quietly do most of the work.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK-registered clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG80, BTS/SIGN and the National Review of Asthma Deaths.

  • 03

    Current for 2026

    Reflects modern UK paediatric asthma care, MART inhalers and biologic options for severe disease.

Key facts

Child asthma at a glance.

The essentials, in plain English - what it is, the main types, and how UK paediatric teams treat it today.

  • What it is

    Chronic inflammatory airway disease of childhood, with reversible bronchoconstriction, mucus and airway hyper-responsiveness.

  • How common

    The most common chronic disease of childhood in the UK, affecting around 1 in 11 children.

  • Main types

    Early-onset atopic, viral-induced wheeze, multiple-trigger wheeze, exercise-induced and severe or difficult asthma.

  • Typical triggers

    Viruses, allergens, cold air, exercise, laughter, emotion, tobacco smoke, pollution and NSAIDs.

  • Foundation therapy

    Regular low-dose inhaled corticosteroid via a spacer, with a reliever inhaler for symptoms and rescue.

  • Preventable deaths

    The National Review of Asthma Deaths found most UK asthma deaths were preventable. Written action plans save lives.

Why this guide matters

Preventer first, plan always.

The National Review of Asthma Deaths found most UK asthma deaths were preventable. The three points below shape everything else on this page.

  • Inhaled steroids are the backbone

    Daily low-dose inhaled corticosteroid via a spacer prevents most attacks and admissions in mild to moderate childhood asthma.

  • Spacers are non-negotiable

    A Volumatic or AeroChamber (with a face mask under 3) more than doubles lung deposition. Direct mouth-to-inhaler is rarely enough.

  • Every child needs a written plan

    A personalised action plan for parents and school, plus an annual review, is the single biggest safety intervention.

How the diagnosis is made

From wheezy toddler to a working plan.

The steps a UK GP, paediatrician or respiratory specialist will normally follow, in the order NICE NG80 and BTS/SIGN recommend.

  1. 01

    Assessing

    History and trigger review

    Recurrent wheeze, night cough, exercise cough, post-viral episodes and family history of atopy, eczema or allergic rhinitis.

  2. 02

    Assessing

    Examination and growth

    Wheeze, hyperinflation, Harrison sulci and atopic features, alongside height and weight tracked on growth charts.

  3. 03

    Assessing

    Peak flow diary

    A two to four week home diary looking for variability of 13 to 20 percent or more between best and worst readings.

  4. 04

    Confirming

    Spirometry with reversibility

    From around age 5, an FEV1 rise of 12 percent or more after a bronchodilator supports the diagnosis.

  5. 05

    Confirming

    FeNO and allergy testing

    Fractional exhaled nitric oxide above 35 ppb in children, plus skin-prick or specific IgE testing where relevant.

  6. 06

    Escalating

    Selective imaging and bloods

    Chest X-ray to exclude other causes when the picture is atypical, plus total IgE and eosinophils in severe cases.

  7. 07

    Escalating

    Specialist paediatric review

    Severe, atypical or steroid-resistant disease is referred to a paediatric respiratory clinic for bronchial challenge and biologic assessment.

Typical timeline: a first GP visit to a settled inhaler plan in a few weeks.

Symptoms

What child asthma actually looks like.

The classic mix of wheeze, cough, breathlessness and chest tightness, with the trigger-driven flares that give asthma away.

  • Recurrent wheeze

    A whistling sound on breathing out, often waxing and waning with viruses, allergens or exercise.

  • Night and early-morning cough

    A dry, repetitive cough that wakes the child or is worst in the early hours is a classic asthma clue.

  • Exercise-induced symptoms

    Cough, wheeze or breathlessness during or shortly after running, football or PE lessons.

  • Post-viral flare-ups

    Colds that reliably drop into the chest and take days or weeks to settle in a wheezy pattern.

  • Chest tightness

    Older children describe a squeezing or heavy feeling in the chest, often alongside breathlessness.

  • Trigger-related pattern

    Symptoms with pets, pollen, dust, cold air, smoke, pollution, laughter or strong emotion.

  • Atopic background

    Eczema, food allergy or hay fever in the child or close family sits behind most early-onset asthma.

  • Red flag - poor response to inhaler

    A child whose reliever is used often, or barely helps, needs urgent review before the next attack.

Treatment

How child asthma is treated in the UK.

Stepwise inhaled therapy first, MART for older children, add-ons and biologics for severe disease - all supported by spacers, action plans and trigger management.

  • Reliever inhaler (SABA)

    Salbutamol via a spacer for symptoms and rescue. Regular need beyond twice a week is a signal to step treatment up.

  • Regular inhaled corticosteroid

    Low-dose beclometasone, budesonide or fluticasone from step 2, taken daily to calm airway inflammation.

  • Leukotriene receptor antagonist

    Montelukast as an add-on, particularly for exercise-induced symptoms and coexisting allergic rhinitis.

  • Long-acting beta agonist (LABA)

    Formoterol or salmeterol added to an ICS in a combination inhaler when a single controller is not enough.

  • MART regimen

    Maintenance and reliever therapy with an ICS-formoterol inhaler (Symbicort SMART, Fostair MART) taken daily and for symptoms.

  • Tiotropium

    A long-acting muscarinic antagonist licensed from age 6 as an add-on when combination inhalers are not enough.

  • Biologics for severe asthma

    Omalizumab, mepolizumab, dupilumab, tezepelumab or benralizumab in specialist paediatric severe-asthma clinics.

  • Written asthma action plan

    A personalised plan for the child, parents and school setting out daily inhalers, warning signs and what to do in an attack.

Learn more about specialist biologic therapy on our asthma biologics clinic page.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or paediatric respiratory team knows your child and can tell you which parts apply to them. In an acute attack, always follow the action plan and, if in doubt, call 999.

  • NICE. Asthma: diagnosis, monitoring and chronic asthma management (NG80).

  • BTS/SIGN. British guideline on the management of asthma (2019).

  • Royal College of Physicians. National Review of Asthma Deaths (NRAD).

  • Asthma + Lung UK. Patient information on childhood asthma and inhaler technique.

Red flags

When child asthma needs urgent attention.

Most asthma is manageable in primary care. These are the situations that are not - and where an urgent, specialist or 999 response is needed.

  • Silent chest or exhaustion

    A quiet chest, drowsiness or inability to speak in full sentences is a life-threatening attack. Call 999.

  • Reliever not lasting

    Symptoms returning within 4 hours of salbutamol, or needing 10 puffs or more, needs same-day emergency review.

  • Cyanosis or oxygen sats below 92%

    Blue lips, grey skin or a pulse oximeter reading under 92 percent is an emergency.

  • Repeated oral steroid courses

    Two or more courses of prednisolone a year, or a hospital attendance, should trigger specialist paediatric referral.

  • Poor inhaler technique

    Most children under 12 need a spacer. Without it, deposition in the airways is poor and control suffers.

  • Growth faltering

    Persistent drops across height centiles on high-dose ICS deserves a specialist review of the regimen.

  • Missed follow-up

    The NRAD report highlighted patients lost to follow-up. Every child on preventer needs a yearly asthma review.

  • Household smoking

    Second-hand smoke is a major, modifiable driver of attacks and hospital admissions.

  • NSAID or beta-blocker exposure

    Ibuprofen or eye drops containing timolol can precipitate severe attacks in sensitive children.

Living with it

A treatable condition, with a clear routine.

Four habits that make the biggest difference day to day - daily preventer, spacer technique, a written plan, and looking after the whole atopic child.

A quiet reminder

Never miss an asthma review.

An annual review, prompt follow-up after any A&E visit, and a plan the school actually has on file are the interventions the NRAD report kept coming back to.

  1. 01 Daily

    Preventer, every day

    The brown or purple preventer works only if taken daily. Link it to teeth brushing to build the habit.

  2. 02 Spacer

    Always use a spacer

    A Volumatic or AeroChamber (with a face mask under 3) more than doubles how much medicine reaches the airways.

  3. 03 Plan

    Written asthma action plan

    Give a copy to the school, childminder and grandparents. It turns a panic into a plan.

  4. 04 Triggers

    Treat the whole atopic child

    Manage eczema, hay fever and food allergy. Keep the home smoke-free and take the flu jab each autumn.

Frequently asked

Everything parents ask about child asthma.

Quick answers on diagnosis, preventer versus reliever, MART inhalers, specialist referral and what to do in an attack.

  • How common is asthma in UK children?

    Asthma affects around 1 in 11 children in the UK, making it the most common chronic disease of childhood. Most present in the pre-school or early school years with recurrent wheeze, cough and breathlessness triggered by viruses, exercise or allergens.

  • How is childhood asthma diagnosed?

    Diagnosis is based on history, examination and objective tests. From about age 5 that includes peak flow variability, spirometry with reversibility, and often FeNO. Younger pre-schoolers are usually managed as viral-induced or multiple-trigger wheeze until formal tests are possible.

  • What is the difference between a preventer and a reliever inhaler?

    A reliever (usually blue salbutamol) opens the airways quickly during symptoms. A preventer contains an inhaled corticosteroid taken daily to reduce underlying inflammation. Most children with anything more than very occasional symptoms need a preventer, not just a reliever.

  • What is a MART inhaler?

    MART stands for Maintenance And Reliever Therapy. It uses a combination inhaler containing an inhaled corticosteroid and fast-acting formoterol (for example Symbicort SMART or Fostair MART) both as a daily preventer and as the reliever for symptoms. It is often preferred in older children and teenagers because it reduces exacerbations.

  • When should a child be seen by a specialist paediatric respiratory team?

    Referral is warranted for diagnostic doubt, severe or brittle disease, poor control despite good adherence, frequent oral steroid courses, growth concerns, or when biologic therapy such as omalizumab, mepolizumab, dupilumab or tezepelumab is being considered.

  • What should we do in an asthma attack?

    Follow the written action plan. Give up to 10 puffs of the reliever through a spacer, one puff at a time with several breaths per puff. If the child is struggling, not improving, drowsy or the reliever is not lasting 4 hours, call 999. Never delay because symptoms seem to ease briefly.

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