Children with apparently mild asthma are still at risk of serious asthmatic exacerbations. Recent studies observed beneficial effects of treatment with anti-inflammatory reliever (AIR) treatment on the risk of asthmatic exacerbations in children. AIR is an approach to asthma management where (most often) a single combination inhaler is used both for quick symptom relief and for treating the underlying airway inflammation, eliminating the need for a separate rescue inhaler. From a patient perspective, use of one inhaler may eliminate the confusion of using different devices for rescue and control. The current Dutch guideline “asthma in children’ does not yet discuss AIR treatment whereas the GINA guideline and BTS/NICE/UK guidelines already include AIR treatment as preferred track or option in step 1 and/or 2 (eg. GINA) in children of age 6 years and older. The role of AIR treatment in younger children with frequent wheezing remains unclear.

PICO

Population: pediatrics with (severe) asthma

Intervention: AIR

Comparator: Placebo or other treatment

Description of studies

Descrition of the systematic reviews
Six randomized controlled trials, which are subtracted from two systematic reviews (Rodriquez-Martinez,2022; Wang, 2017) and two randomized controlled trials  (Reddel, 2021; Hatter, 2025) reported on the relevant outcome measures and were included in the analysis of the literature.

Desription of review by Rodriquez-Martinez (2022)
Rodriquez-Martinez (2022) is a narrative review which summarized findings of RCT’s that evaluated the use of ICS on intermittent or as-needed basis, as an add-on therapy to SABA’s of fast-acting β2-agonists (FABA’s), with or without use of ICS in stable period of asthmatic disease and versus an active comparator. Studies were included if 1) patients were less than 18 years with wheezing or asthma symptoms 2) studies reported on clinical efficacy or safety 3) data could be extracted. Quality of the evidence was scored using Cochrane Risk of Bias tools for RCTs, and AMSTAR 2 for systematic reviews. However, this information was not published in the article, therefore articles are each individually scored on bias. Sixteen studies were included in the review of which six studies are included within this current guideline, in the following subgroups:

• Pediatrics only group (0-5 years): Ducharme (2009), Bisgaard (2006a), Bacharier (2008), Zeiger (2011).
• Pediatrics and adolescents (6-18 years): Camargos (2018), Sumino (2020).

Description of systematic review by Wang (2017)

Wang (2017) is a systematic review that explored the efficacy and safety of the as needed use of ICS plus FABA regimen in a single inhaler versus the as-needed use of FABA regimen and the daily use of ICS regimen. Studies were included if 1) children and adults have intermittent and mild persistent asthma and 2) the as-needed intervention could be as only one or two separate inhalers. This review followed PRISMA guidelines and a total of 5 databases were researched among wich MEDLINE, EMBASE and CENTRAL. Quality of the evidence was scored using Cochrane Risk of Bias tools for RCTs. Primary outcome was asthma exacerbation, whereas secondary outcomes were forced expiatory volume in one second (FEV1) and serious adverse events (amongst others).  Six studies were included in the review of which three studies are included within this current guideline.
The following articles were included in the article of Wang (2017) ánd Rodriquez Martinez (2022); however, the analysis by Wang was used, as it provided a more comprehensive evaluation, per population group:

• Pediatrics only group (0-5 years): Papi (2009), Fitzpatrick (2016)
• Pediatrics and adolescents (6-18 years): Martinez (2011)
  

Description of RCT’s

The following individual trials are included and analyzed per subgroup:

Preschool and early school aged children group (0-5 years)
Our included reviews included the following trials:

1. Bisgaard (2006a)
   A single-center, randomized, double blind, prospective study for three years with the aim to determine whether use of inhaled corticosteroid during symptomatic episodes delays progression to persistent wheezing (defined as symptoms affecting the child’s breathing resulting in wheezing/whistling sounds, breathlessness, shortness of breath or persistent troublesome coughing). A total of 411 infants were included but only 301 infants underwent randomization (since 110 did not undergo wheezing episodes).
2. Bacharier (2008)
   A randomized, double-blind placebo-controlled trial for 12 months at 5 clinical centers in the US, with the aim to examine effectiveness of episodic use of an inhaled corticosteroid (ICS) and leukotriene receptor antagonist (LTRA) in preschoolers with moderate-severe intermittent wheezing. A total of 238 children, aged 12 to 59 months, were included.
3. Ducharme (2009)
   A parallel-group, randomized placebo-controlled trial with triple blinding in 5 institutions in Canada (Quebec) for 6 to 12 months with the aim to determine preemptive treatment with rescue systemic corticosteroids recuses severity of recurrent virus-induced wheezing. A total of 129 children, age 1 to 6 years, were included.
4. Zeiger (2011)
   A randomized, double-blind, parallel-group trial at seven sites for 1 year with the aim to compare daily therapy with intermittent therapy. A total of 278 children, aged 12 to 53 months, were included.
5. Papi (2009)
   A multicenter, randomized, double-blind, open run-in parallel trial in Italy for 12 weeks to determine the clinical effect of regular nebulized glucocorticoid and a prn (pro re nata (as needed)) bronchodilitator versus the simple prn use of a nebulized bronchodilitator/glucorticoid combination and no regular treatments versus a prn bronchodilitator alone.  A total of 274 patients, aged 1-4 with frequent wheezing periods were included.
6. Fitzpatrick (2016)
   A multicenter, randomized, double-blind, double-dummy clinical trial cross over trial (INFANT trial) in USA for 16 weeks with the aim to determine the differential responses to three different strategies and whether phynotpic presentations in young children with asthma may contribute to different responses. A total of 300 patients, aged 12 to 59 months with asthma according to (ERP-3 guideline) were included.

School age children and adolescents (6-18 years)
Our included reviews included the following trials:

1. Camargos (2018)
   A two-arm, parallel, randomized open-label (i.e. with no placebo control) study for 16 weeks in three centers in Brazil. The aim was to compare efficacy of the intermittent use of beclomethasone with that of continuous use. A total of 188 children with mild persistent asthma (6–18 years old) were included.
2. Sumino (2020)
   A pragmatic, open-label, 2-arm, pragmatic trial in 12 participating PCPs in Saint Louis in African American children. The aim was to evaluate the effectiveness of symptom-based adjustment of ICS. A total of 206 African American children (6–17 years old) with mild asthma were included.
3. Martinez (2011)
   A randomized, double blind, placebo-controlled trial in 5 centers in the USA. The aim was to assess the effectiveness of an ICS (beclomethasone dipropionate) as rescue treatment. A total of 288 children and adolescents with mild persistent asthma (5-18 years old) were included.

Also included are:

4. Reddel (2021), SYGMA trials
   A post-hoc analysis of two trials of Symbicort Given as-needed in mild asthma (SYGMA). SYGMA 1 (NCT02149199) and SYGMA 2 (NCT02224157) trials were double-blind, randomized, multinational, parallel-group studies for 52 weeks. The aim was to investigate the efficacy of as-needed BUD-FORM versus as-needed terbutaline and BUD maintenance. Reddel included a subgroup of 889 adolescents (aged >12 to < 18 years) from the SYGMA trials in the post-hoc analysis.
5. Hatter (2025), CARE trial
   The Children’s Anti-Inflammatory Reliever (CARE) study is an open-label, parallel-group, multicentre, superiority, randomized controlled trial at 15 clinics sited in New Zealand for 52 weeks. The aim was to compare the efficacy and safety of the as-needed budesonide-formoterol with the as-needed salbutamol. A total of 360 children (5-15 years) with asthma using only SABA were included.

Important study characteristics and results are summarized in table 2 per included trial. The assessment of the risk of bias is summarized in the risk of bias tables (under the tab ‘Evidence tables’).

Results
All asthma exacerbation frequency:

All exacerbation frequency 0-5 years

Three studies reported on all excacerbation frequency (see Table 3). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups and type of effect estimates. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 3. All asthma exacerbations frequency as reported by included studies.

*Data obtained from both the article Rodriquez-Martinez (2022) and individual studies.
**Data obtained from Wang, 2017. In Papi (2009), asthma exacerbations is defined as frequency of asthma excacerbation. Absolute numbers are, however, not reported in both Papi (2009) and Wang (2017).

All exacerbation frequency 6-18 years

Four studies reported on all excacerbation frequency (see Table 4). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups and type of effect estimates. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 4. All asthma exacerbations frequency as reported by included studies.

*Data obtained from both the article Rodriquez-Martinez (2022) and individual studies.
**Data obtained from Wang, 2017. Absolute numbers are not reported in Wang (2017). Martinez (2011) reported the probability of a first exacerbation, but not absolute numbers for frequency of exacerbations.

Severe excacerbation frequency
Severe exacerbation frequency 0-5 years

Two studies reported on severe excacerbation frequency (see Table 5). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups and type of effect estimates. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 5. Severe asthma exacerbations frequency as reported by included studies.

*Data obtained from both the article Rodriquez-Martinez (2022) and individual studies.
**Data obtained from Wang, 2017. Wang (2017) reported the same risk ratio for ‘all exacerbations’. We did not include these results because Fitzpatrick defined exacerbations as events requiring systemic corticosteroids, which primarily captures severe exacerbations rather than all exacerbation events.

Severe exacerbation frequency 6-18 years

Four studies reported on severe excacerbation frequency (see Table 6). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups and type effect estimates. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 6. Severe asthma exacerbations frequency as reported by included studies.

* Data obtained from Wang, 2017. Absolute numbers are not reported in Wang (2017). Martinez (2011) reported the probability of a first exacerbation (for all exacerbations), but not absolute numbers for frequency of severe exacerbations.

**Wang (2017) reported the same number of severe exacerbations as the total number of exacerbations, whereas the original article by Martinez (2011) did not report data on severe exacerbations. Nevertheless, these data are included in the table for transparency.

Symptom free days
Symptom free days 0-5 years

Four studies reported on symptom free days (see Table 7). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups and type of effect estimates. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 7. Symptom free days as reported by included studies.

*Data obtained from both the article Rodriquez-Martinez (2022) and individual studies.

Symptom free days 6-18 years
Included studies did not report on symptom free days for patients aged 6 to 18 years.

OCS rescue dose medication
OCS rescue dose medication 0-5 years
Five studies reported on OCS rescue dose medication (see Table 8). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups and type of effect estimates. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 8. OCS rescue dose medication as reported by included studies.

*Data obtained from both the article Rodriquez-Martinez (2022) and individual studies.

OCS rescue dose medication 6-18 years
Included studies did not report on OCS rescue dose for patients aged 6 to 18 years.

Disease specific quality of life

Disease specific quality of life 0-5 years
Three studies reported on disease specific quality of life using the Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLC) and the Infant Toddler Quality of Life Domains (see Table 9). The studies differed in comparison and intervention groups. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 9. Disease specific quality of life as reported by included studies.

*Data obtained from both the article Rodriquez-Martinez (2022) and individual studies.
** Data obtained from individual article.

Disease specific quality of life 6-18 years
Included studies did not report on the defined Disease specific quality of life measure patients aged 6 to 18 years (or was not reported the original study).

Composite score (asthma control and symptoms)

Composite score (asthma control and symptoms) 0-5 years
Three studies reported on either asthma control of asthma symptom severity/intensity (see Table 10). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups and type of effect estimates. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 10. Composite score (asthma control and symptoms) as reported by included studies.

*Data obtained from both the article Rodriquez-Martinez (2022) and individual studies.
** Data obtained from individual article.

Composite score (asthma control and symptoms) 6-18 years
Five studies reported on either asthma control of asthma symptom severity/intensity (see Table 11). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 11. Composite score (asthma control and symptoms) as reported by included studies.

*Data obtained from both the article Rodriquez-Martinez (2022) and individual studies.

Improvement in lung function

Change in FEV_{1 :} 0-5 years

Included studies did not report on change in FEV₁ in patients aged 0 to 5 years.

Change in FEV₁:  6-18 years
Five studies reported on either asthma control of asthma symptom severity/intensity (see Table 12). The studies differed in follow-up duration, comparison and intervention groups. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 12. Improvement in lung function (as reported by included studies).

*Data obtained from both the article Rodriquez-Martinez (2022) and individual studies.

Change in growth

Change in growth 0-5 years
Four studies reported on change in growth (see Table 13). The studies differed in their, follow-up duration, comparison and intervention group. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 13. Change in growth as reported by included studies.

*Data obtained from individual article.

Change in growth 6-18 years
Four studies reported on change in growth (see Table 14). The studies differed in their, definitions, follow-up duration, comparison and intervention group. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 14. Change in growth as reported by included studies.

Adverse events 
Adverse events 0-5 years
Three studies reported on adverse events (see Table 15). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 15. Adverse events as reported by included studies.

*Data obtained from supplements from each individual article.
**Data obtained from individual article

Adverse events 6-18 years

Three studies reported on adverse events (see Table 16). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 16. Adverse events as reported by included studies.

Hospitalization
Hospitalization_: 0-5 years
Four studies reported on hospitalization (see Table 11). The studies differed in their definitions of this outcome measure, follow-up duration, comparison and intervention groups. Due to these differences, data of studies could not be pooled and overall conclusions could not be drawn.

Table 11. Hospitalization as reported by included studies.

*Data obtained from both the article Rodriquez-Martinez (2022) and individual studies.
**Data obtained from supplement of individual article

Hospitalization_: 6-18 years
One study reported on hospitalization (see Table 17), with a low number of events. Conclusions will therefore not be drawn

Table 17. Hospitalization as reported by included studies.

A systematic review of the literature was performed to answer the following question(s):

What are the favorable and unfavorable effects of AIR, compared with placebo or care as usual, in children with asthma? 

Table 1. PICO

Relevant outcome measures

The guideline panel considered improvement in exacerbation frequency, composite score of asthma symptoms and asthma control, symptom free days and hospitalization as critical outcome measures for decision making; and disease specific quality of life, improvement in lung function, OCS rescue dose medication, change in growth and adverse events as important outcome measures for decision making.

A priori, the guideline panel did not define the outcome measures listed above but used the definitions used in the studies. The guideline panel emphasizes the importance of using a core outcome set (COS) in future studies on AIR in the pediatric population (Khaleve 2023). These standardized outcome measures will facilitate comparability across studies and may also be used in future guideline development.

The guideline panel focusses on the most important outcomes and defined the following thresholds as a minimal clinically (patient) important difference for each outcome measure:

Search and select (Methods)

A systematic literature search was performed by a medical information specialist using the following bibliographic databases: Embase.com and Ovid/Medline. Both databases were searched from 01-01-2000 to 7-04-2025 for systematic reviews and RCTs. Searches were completed using a combination of controlled vocabulary/subject headings (e.g., Emtree-terms, MeSH) wherever they were available and natural language keywords. The overall search strategy was derived from two primary search concepts: (1) asthma 2) children and (3) anti-inflammatory reliever therapy (AIR)/single maintenance and reliever therapy (SMART/MART). Duplicates were removed using EndNote software. After deduplication a total of 1115 records were imported for title/abstract screening. This search was update from 7^th of April to 23^rd of October 2025, using only AIR search terms resulting in an additional 21 articles.
Initially, 10 studies were selected based on title and abstract screening based on the PICO criteria. After reading the full text, 6 studies were excluded (see the exclusion table under the tab ‘Evidence tabellen’), and 4 studies were included. Two studies are (systematic) reviews (Rodriquez-Martinez 2022, Wang 2017), one study is a post-hoc analysis of two randomized controlled trials (RCT’s) (Reddel, 2021) and one study is an individual RCT (Hatter, 2025). The review of Rodriquez-Martinez included six RCT’s that fulfilled our inclusion criteria and Wang included three RCT’s that fulfilled our inclusion criteria. Other studies included in their review are excluded within this guideline. 
Studies that report on MART in adolescents and/or pediatrics will be described in a separate chapter of this guideline.

1. Bacharier LB, Phillips BR, Zeiger RS, Szefler SJ, Martinez FD, Lemanske RF Jr, Sorkness CA, Bloomberg GR, Morgan WJ, Paul IM, Guilbert T, Krawiec M, Covar R, Larsen G, Mellon M, Moss MH, Chinchilli VM, Taussig LM, Strunk RC; CARE Network. Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate-to-severe intermittent wheezing. J Allergy Clin Immunol. 2008 Dec;122(6):1127-1135.e8. doi: 10.1016/j.jaci.2008.09.029. Epub 2008 Oct 30. PMID: 18973936; PMCID: PMC2753208.
2. Bisgaard H, Hermansen MN, Loland L, Halkjaer LB, Buchvald F. Intermittent inhaled corticosteroids in infants with episodic wheezing. N Engl J Med. 2006 May 11;354(19):1998-2005. doi: 10.1056/NEJMoa054692. PMID: 16687712.
3. Bonini M, Di Paolo M, Bagnasco D, Baiardini I, Braido F, Caminati M, Carpagnano E, Contoli M, Corsico A, Del Giacco S, Heffler E, Lombardi C, Menichini I, Milanese M, Scichilone N, Senna G, Canonica GW. Minimal clinically important difference for asthma endpoints: an expert consensus report. Eur Respir Rev. 2020 Jun 3;29(156):190137. doi: 10.1183/16000617.0137-2019. PMID: 32499305; PMCID: PMC9488652.
4. Camargos P, Affonso A, Calazans G, Ramalho L, Ribeiro ML, Jentzsch N, Senna S, Stein RT. On-demand intermittent beclomethasone is effective for mild asthma in Brazil. Clin Transl Allergy. 2018 Mar 5;8:7. doi: 10.1186/s13601-018-0192-0. PMID: 29515802; PMCID: PMC5836456.
5. Ducharme FM, Lemire C, Noya FJ, Davis GM, Alos N, Leblond H, Savdie C, Collet JP, Khomenko L, Rivard G, Platt RW. Preemptive use of high-dose fluticasone for virus-induced wheezing in young children. N Engl J Med. 2009 Jan 22;360(4):339-53. doi: 10.1056/NEJMoa0808907. PMID: 19164187.
6. Fitzpatrick AM, Jackson DJ, Mauger DT, Boehmer SJ, Phipatanakul W, Sheehan WJ, Moy JN, Paul IM, Bacharier LB, Cabana MD, Covar R, Holguin F, Lemanske RF Jr, Martinez FD, Pongracic JA, Beigelman A, Baxi SN, Benson M, Blake K, Chmiel JF, Daines CL, Daines MO, Gaffin JM, Gentile DA, Gower WA, Israel E, Kumar HV, Lang JE, Lazarus SC, Lima JJ, Ly N, Marbin J, Morgan W, Myers RE, Olin JT, Peters SP, Raissy HH, Robison RG, Ross K, Sorkness CA, Thyne SM, Szefler SJ; NIH/NHLBI AsthmaNet. Individualized therapy for persistent asthma in young children. J Allergy Clin Immunol. 2016 Dec;138(6):1608-1618.e12. doi: 10.1016/j.jaci.2016.09.028. Epub 2016 Oct 21. PMID: 27777180; PMCID: PMC5148729.
7. Hatter L, Holliday M, Oldfield K, Kearns C, Barry T, Black M, Bruce P, Colman A, Dickinson E, Eathorne A, Harwood M, Hills T, Lamb R, Kerse K, Krishnamoorthy S, Martindale J, Semprini A, Shortt N, McNamara D, Byrnes CA, Dalziel SR, Bush A, Weatherall M, Beasley R; CARE study team. Budesonide-formoterol versus salbutamol as reliever therapy in children with mild asthma (CARE): a 52-week, open-label, multicentre, superiority, randomised controlled trial. Lancet. 2025 Oct 4;406(10511):1473-1483. doi: 10.1016/S0140-6736(25)00861-X. Epub 2025 Sep 28. PMID: 41033330.
8. Jones PW. Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J. 2002 Mar;19(3):398-404. doi: 10.1183/09031936.02.00063702. PMID: 11936514.
9. Juniper EF, Guyatt GH, Willan A, Griffith LE. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol. 1994 Jan;47(1):81-7. doi: 10.1016/0895-4356(94)90036-1. PMID: 8283197
10. Khaleva E, Rattu A, Brightling C, Bush A, Bossios A, Bourdin A, et al. Development of Core Outcome Measures sets for paediatric and adult Severe Asthma (COMSA). Eur Respir J. 2023 Apr 3;61(4):2200606. doi:10.1183/13993003.00606-2022. PMID: 36229046; PMCID: PMC10069873.
11. Loke YK, Blanco P, Thavarajah M, Wilson AM. Impact of Inhaled Corticosteroids on Growth in Children with Asthma: Systematic Review and Meta-Analysis. PLoS One. 2015 Jul 20;10(7):e0133428. doi: 10.1371/journal.pone.0133428. PMID: 26191797; PMCID: PMC4507851.
12. Martinez FD, Chinchilli VM, Morgan WJ, Boehmer SJ, Lemanske RF Jr, Mauger DT, Strunk RC, Szefler SJ, Zeiger RS, Bacharier LB, Bade E, Covar RA, Friedman NJ, Guilbert TW, Heidarian-Raissy H, Kelly HW, Malka-Rais J, Mellon MH, Sorkness CA, Taussig L. Use of beclomethasone dipropionate as rescue treatment for children with mild persistent asthma (TREXA): a randomised, double-blind, placebo-controlled trial. Lancet. 2011 Feb 19;377(9766):650-7. doi: 10.1016/S0140-6736(10)62145-9. Epub 2011 Feb 14. PMID: 21324520; PMCID: PMC4852146.
13. Mohangoo AD, de Koning HJ, de Jongste JC, Landgraf JM, van der Wouden JC, Jaddoe VW, Hofman A, Moll HA, Mackenbach JP, Raat H. Asthma-like symptoms in the first year of life and health-related quality of life at age 12 months: the Generation R study. Qual Life Res. 2012 Apr;21(3):545-54. doi: 10.1007/s11136-011-9957-9. Epub 2011 Jul 27. PMID: 21792733.
14. National Institute for Health and Care Excellence (NICE). Asthma: diagnosis, monitoring and chronic asthma management (BTS/NICE/SIGN). NICE Guideline NG245. London: NICE; 2024. Available from: https://www.nice.org.uk/guidance/NG245
15. Papi A, Nicolini G, Baraldi E, Boner AL, Cutrera R, Rossi GA, Fabbri LM; BEclomethasone and Salbutamol Treatment (BEST) for Children Study Group. Regular vs prn nebulized treatment in wheeze preschool children. Allergy. 2009 Oct;64(10):1463-1471. doi: 10.1111/j.1398-9995.2009.02134.x. PMID: 19772514.
16. Price J, Hindmarsh P, Hughes S, Efthimiou J. Evaluating the effects of asthma therapy on childhood growth: what can be learnt from the published literature? Eur Respir J. 2002 Jun;19(6):1179-93. doi: 10.1183/09031936.02.00288702. PMID: 12108874.
17. Raat H, Landgraf JM, Oostenbrink R, Moll HA, Essink-Bot ML. Reliability and validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) in a general population and respiratory disease sample. Qual Life Res. 2007 Apr;16(3):445-60. doi: 10.1007/s11136-006-9134-8. Epub 2006 Nov 17. PMID: 17111231; PMCID: PMC2792359.
18. Reddel HK, O'Byrne PM, FitzGerald JM, Barnes PJ, Zheng J, Ivanov S, Lamarca R, Puu M, Alagappan VKT, Bateman ED. Efficacy and Safety of As-Needed Budesonide-Formoterol in Adolescents with Mild Asthma. J Allergy Clin Immunol Pract. 2021 Aug;9(8):3069-3077.e6. doi: 10.1016/j.jaip.2021.04.016. Epub 2021 Apr 22. PMID: 33895362.
19. Rodriguez-Martinez CE, Sossa-Briceño MP, Garcia-Marcos L. Use of inhaled corticosteroids on an intermittent or as-needed basis in pediatric asthma: a systematic review of the literature. J Asthma. 2022 Nov;59(11):2189-2200. doi: 10.1080/02770903.2021.2008430. Epub 2021 Nov 26. PMID: 34806537.
20. Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Aliverti A, Barjaktarevic I, Cooper BG, Culver B, Derom E, Hall GL, Hallstrand TS, Leuppi JD, MacIntyre N, McCormack M, Rosenfeld M, Swenson ER. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022 Jul 13;60(1):2101499. doi: 10.1183/13993003.01499-2021. PMID: 34949706
21. Sumino K, Bacharier LB, Taylor J, Chadwick-Mansker K, Curtis V, Nash A, Jackson-Triggs S, Moen J, Schechtman KB, Garbutt J, Castro M. A Pragmatic Trial of Symptom-Based Inhaled Corticosteroid Use in African-American Children with Mild Asthma. J Allergy Clin Immunol Pract. 2020 Jan;8(1):176-185.e2. doi: 10.1016/j.jaip.2019.06.030. Epub 2019 Jul 30. PMID: 31371165.
22. Voorend-van Bergen S, Vaessen-Verberne AA, Landstra AM, Brackel HJ, van den Berg NJ, Caudri D, de Jongste JC, Merkus PJ, Pijnenburg MW. Monitoring childhood asthma: web-based diaries and the asthma control test. J Allergy Clin Immunol. 2014 Jun;133(6):1599-605.e2. doi: 10.1016/j.jaci.2013.10.005. Epub 2013 Nov 28. PMID: 24290276.
23. Wang G, Zhang X, Zhang HP, Wang L, Kang Y, Barnes PJ, Wang G. Corticosteroid plus β2-agonist in a single inhaler as reliever therapy in intermittent and mild asthma: a proof-of-concept systematic review and meta-analysis. Respir Res. 2017 Dec 6;18(1):203. doi: 10.1186/s12931-017-0687-6. PMID: 29207999; PMCID: PMC5718039.
24. Wilson SR, Rand CS, Cabana MD, Foggs MB, Halterman JS, Olson L, Vollmer WM, Wright RJ, Taggart V. Asthma outcomes: quality of life. J Allergy Clin Immunol. 2012 Mar;129(3 Suppl):S88-123. doi: 10.1016/j.jaci.2011.12.988. PMID: 22386511; PMCID: PMC4269375.
25. Zeiger RS, Mauger D, Bacharier LB, Guilbert TW, Martinez FD, Lemanske RF Jr, Strunk RC, Covar R, Szefler SJ, Boehmer S, Jackson DJ, Sorkness CA, Gern JE, Kelly HW, Friedman NJ, Mellon MH, Schatz M, Morgan WJ, Chinchilli VM, Raissy HH, Bade E, Malka-Rais J, Beigelman A, Taussig LM; CARE Network of the National Heart, Lung, and Blood Institute. Daily or intermittent budesonide in preschool children with recurrent wheezing. N Engl J Med. 2011 Nov 24;365(21):1990-2001. doi: 10.1056/NEJMoa1104647. PMID: 22111718; PMCID: PMC3247621.
26. Zorginstituut Nederland. Transmurale leidraad klimaatbewust voorschrijven van inhalatiemedicatie. Diemen: Zorginstituut Nederland; 2025. Available from: https://www.zorginstituutnederland.nl/documenten/2025/04/09/transmurale-leidraad-klimaatbewust-voorschrijven-van-inhalatiemedicatie