-Airflow obstruction
-Bronchial smooth muscle spasm
-Edema of airway mucosa
-Mucous impaction of bronchi
-Airway inflammation
-Airway hyperresponsiveness

-Even if patient has poorly controlled asthma the physical examination may be completely normal.
-During an acute exacerbation, physical examination may show wheezing with reduced airflow, prolonged expiratory phase, use of accessory muscles, tachypnea,

In school-aged children, the diagnosis can be made by the history and pulmonary function testing. In a child with active asthma, there may be a reduction in the FEV1 and the FEV1/FVC ratio.

-In children under 5, the history and the response to bronchodilator or anti-inflammatory therapy are the keys to diagnosis.

-Trigger identification and avoidance
-Patient education about inhaler technique, monitoring disease activity, etc.
-Some patients may be advised to use peak flow meters to help monitor disease severity and provide an early warning
-Written action plan

Inhaled corticosteroids.

1. General environmental control measures for all children (e.g. avoidance of environmental tobacco smoke) and specific allergen avoidance measures guided by allergy testing.
2. Patient education, written action plan and follow-up for all children

a. Start with low-dose inhaled corticosteroids, increasing dose if needed to achieve and maintain control. May also start with a moderate-high dose inhaled corticosteroids until well-controlled and then weaning to lowest dose that maintains good control

-Generally excellent. Many children with mild symptoms “outgrow” their asthma.
-Deaths tend to result from under-recognition of symptom severity or from undertreatment.