For children aged five to 16, the NICE treatment pathway for asthma is similar to adults. A paediatric low dose of inhaled corticosteroid (ICS) should be offered alongside short-acting beta2 agonist (SABA) reliever therapy. If this is not sufficient to control symptoms, then a leukotriene receptor antagonist (LTRA) can be added, followed by a long-acting beta2 agonist (LABA). If their asthma is still not controlled, maintenance and reliever therapy (MART) can be considered, noting that only Symbicort is licensed for people aged 12 and over for MART. 

For children under five, NICE recommends considering an eight-week trial of paediatric moderate dose of ICS alongside SABA reliever therapy, after which, treatment should be stopped and symptoms monitored. If symptoms didn’t resolve during the trial, an alternative diagnosis should be considered. If the trial resolved symptoms which then reoccurred beyond four weeks of stopping the treatment, then the trial should be repeated. If the trial resolved symptoms which then reoccurred within four weeks of stopping the treatment, then the ICS should be restarted at a paediatric low dose. If this does not control their asthma then a LTRA can be added. If their asthma is still uncontrolled, they should be referred to a specialist.