Clinical guidelines for the care of children aged under 5 with asthma: An overview of the recent national guidelines

Asthma is the most common long-term condition amongst children and young people and is one of the top ten reasons for emergency hospital admission in the UK (Royal College of Paediatrics and Child Health, 2020). Asthma and Lung UK reported (2022) that the UK has the worst death rate for lung conditions such as asthma and chronic obstructive pulmonary disease (COPD) than anywhere else in western Europe. Given how common is, and how poorly the UK compares, it is critical that nurses in primary and community services understand what has been described as a ‘sea change’ in national guidelines (Hickman, 2024; BTS/SIGN/NICE, 2024).

These new guidelines resolve longstanding differences between the previous BTS and SIGN guidelines, and NICE guidelines. In addition, health professionals describe the new guidelines as an opportunity for an ‘upgrade’ people's inhalers (PCRS, 2025). For example, for older children and adults, this might mean a move (where clinically indicated) towards maintenance and reliever therapy (MART) regimes, enabling people to receive controller medication alongside a long acting reliever with every dose, thus reducing the reliance on short acting bronchodilators (SABA), which can be associated with poor control and increased exacerbations (GINA, 2024). Diagnostic testing has also changed in those aged 5 and over, with a move towards blood eosinophils or fractional exhaled nitric oxide (FeNO) as the first line. The following paragraph and algorithm references refer to the 2024 BTS/SIGN/NICE guidelines.