Table 5.

Building blocks to reduce worldwide morbidity and mortality in children with asthma

A: Local requirement

Choose an asthma champion within a health care system to lead and implement a population health model including prevention and treatment of children using tobacco products and e‐cigarettes. Ensure full recognition that an asthma attack is a risk factor for a future asthma attack and must lead to a reevaluation of asthma care to prevent further attacks Build a registry of children with moderate to severe asthma. Follow each child's asthma life‐course with repeated lung function trajectory measurements, especially those with moderate to severe asthma characterized by frequent asthma attacks. Utilize assessments, which may need local adaption, for example, the Composite Asthma Severity Index (CASI) to identify children with the greatest burden of asthma. Support the establishment of school nurses or other local asthma champions, such as community health workers, in all schools to support asthma management. Adopt a population asthma management strategy locally and implemented regionally using community resources. Develop a registry run by academic centers to coordinate data collection for national and international collaboration to increase understanding of mechanisms relating to asthma onset and progression.

B: National requirement

Using the Global Initiative for Asthma (GINA) as a template, develop national guidance individualized to enable regulatory approval of effective medications. Develop teaching capacity particularly in primary care to ensure that knowledge transfer leads to clinical behavioral change. Consider the “Teach the Teacher” model from the International Primary Care Respiratory Group; the curriculum of which is adaptable for local needs. Standardize quality of care within health care systems and academic centers to enable reimbursement based on quality improvement. Identify children with a high burden of asthma and ensure the availability for asthma specialist referral. Set up process to monitor outcomes across health care systems to define standards of care and improve quality.

C: International requirement

The Global Initiative for Asthma (GINA) strategy should continue as the basis for effective asthma management but be modified and simplified as needed by individual countries with increased participation from primary care. The global strategy should be child‐centred and adapted for implementation in the community. Guidance on “difficult to treat asthma” needs regular review based on the introduction of newer medications or management strategies. Strategies are needed to ensure primary care clinicians and their support staff, including community health workers, are trained and confident to manage children with mild to moderate asthma with clear pathways for specialist referral if the asthma is not responding to low dose treatment. The World Health Organization should monitor the use of appropriate medications including inhaled corticosteroids and rescue therapy and spacers and encourage their availability in all countries but particularly in low and middle‐income countries (LMICs). Each country should ensure there is sufficient knowledge and support for primary care physicians to successfully manage asthma. An international collaborative of academic centers is required to facilitate research into the geographic differences of asthma in children. The international collaborative should harmonize terminology and data collection systems to enable research into the components of asthma including the effect of interventions and management strategies. This international collaborative should publish data which will inform GINA and the asthma community as a whole on the worldwide asthma management in children and recommend variations according to regional differences.

Note: The Tables set out broad general principles, but the detailed practical implementation will depend on the setting, and should be determined in partnership between local communities and health care professionals.