Asthma affects 6 million US children under 18, causing 1.6 million ED visits and 100,000 hospitalizations annually — making it the leading chronic illness causing school absenteeism. The 2020 NAEPP (National Asthma Education and Prevention Program) Expert Panel Report 3 update introduced meaningful changes to stepwise therapy that primary care providers, pediatricians, and pulmonologists need to incorporate.
NAEPP 2020 Key Changes
Single maintenance and reliever therapy (SMART): the 2020 NAEPP update now endorses SMART — using inhaled corticosteroid/formoterol (budesonide-formoterol) as both daily controller AND rescue inhaler in patients ≥5 years old with moderate-severe asthma. Multiple RCTs show SMART reduces severe exacerbations by 30–40% versus separate controller + SABA rescue — largely by ensuring patients take ICS with every rescue dose. Allergen immunotherapy (AIT): NAEPP strengthens AIT recommendation as adjunct therapy for allergic asthma — 3–5 year subcutaneous or sublingual immunotherapy produces durable allergen-specific tolerance reducing both medication requirements and exacerbation rates. Removing SABAs as monotherapy: for patients ≥12 years old who need a SABA inhaler more than twice per week, step-up to ICS is now recommended — SABA-alone therapy is considered inadequate controller therapy per 2020 guidelines.
Biologics for Severe Pediatric Asthma
Dupilumab (Dupixent) anti-IL-4/13: FDA-approved for children ≥6 years with moderate-severe Type 2 (eosinophilic or atopic) asthma. VOYAGE trial showed 65% reduction in annualized severe exacerbations. Mepolizumab (Nucala) anti-IL-5: approved ≥6 years, reduces exacerbations 53% in eosinophilic asthma (blood eos ≥150). For respiratory management in pediatric settings, our respiratory section includes nebulizers, spacer/holding chambers, peak flow meters, and oxygen delivery equipment for pediatric patients, and our pediatric supply catalog includes age-appropriate respiratory and monitoring supplies.
