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

View all recommendations from this society

Released August 17, 2020

Do not use LABA/steroid combination drugs as initial therapy for intermittent or mild persistent asthma.

Long acting beta agonist (LABA) medications provide sustained bronchodilation over a 12- to 24-hour period after delivery. For the treatment of asthma, they are supplied in combination with an inhaled steroid medication via a metered dose inhaler (MDI) or dry powder inhaler (DPI). Children with intermittent asthma have only occasional need for bronchodilators and do not benefit from the use of LABAs on a daily basis. Children with mild persistent asthma are usually well-controlled with a single agent – either a leukotriene modifier or a low-dose inhaled corticosteroid medication. The addition of a LABA is not recommended in these circumstances and should be reserved for children with moderate persistent or severe persistent asthma.

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