American Academy of Pediatrics – Section on Pediatric Pulmonology and Sleep Medicine

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Released August 17, 2020

Avoid stepping up asthma therapy (adding new drugs or going to higher doses) before assessing adherence, appropriateness of device, and technique with current asthma medications.

The 2007 Expert Panel report from the National Asthma Education & Prevention Program discusses in detail the importance of monitoring asthma control in pediatric patients, stepping up therapy, and stepping down therapy, when appropriate. There are key evaluations that should occur before stepping up therapy, though. Providers should first review with the family how they are administering the present asthma medications to determine whether the asthma controller is being administered properly and effectively for the age of the patient. Another evaluation is to confirm adherence both by discussion with the family and learning the refill history from the pharmacy. It is also important to explore other barriers to adherence for the patient and family. There is no reason to step up to a higher-dose steroid inhaler or to a combination therapy if the patient is not receiving the lower dose asthma controller with the correct technique and frequency.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The AAP Section on Pediatric Pulmonology and Sleep Medicine (SOPPSM) expressed interest in Choosing Wisely at Celebration of Pediatric Pulmonology in 2015. Over the course of the 2-day meeting, group breakouts occurred during which the attendees identified the top 21 potential Choosing Wisely recommendations. These were voted on and ranked by the attendees. The AAP Section on Pediatric Pulmonology and Sleep Medicine (SOPPSM) membership was then surveyed to select the top 5 items on the basis of the scientific evidence provided. The list was extensively peer reviewed, refined, and approved by all relevant AAP Committees, Councils, and Sections. The AAP Board of Directors and Executive Committee awarded the final approval.

AAP’s disclosure and conflict of interest policy can be found at


National Asthma Education & Prevention Program. Expert Panel Report III: Guidelines for the Diagnosis & Management of Asthma. Bethesda, MD: National Heart, Lung, and Blood Institute; 2007.

Weinberger M. Asthma. In: Light M, ed. Pediatric Pulmonology. Elk Grove Village, IL: American Academy of Pediatrics; 2011:250-261.

Yawn B. The role of the primary care physician in helping adolescent and adult patients improve asthma control. Mayo Clin Proc. 2011;86(9):894-902.