Bronchial asthma is one of the most common chronic respiratory disorders in children and significantly impacts quality of life. Stepwise treatment approaches, as recommended by international guidelines, have been developed to tailor therapy according to disease severity. This study aims to comparatively evaluate the clinical outcomes and safety profiles of different stepwise treatment regimens in pediatric patients with bronchial asthma. In a prospective, multicenter observational study conducted from January 2021 to December 2023, 500 children aged 6 to 15 years diagnosed with persistent asthma were enrolled and managed according to one of three treatment protocols. Data were collected on asthma control (assessed by the Asthma Control Test [ACT]), lung function parameters, frequency of exacerbations, and adverse events. Statistical analyses revealed that while all three stepwise regimens improved asthma control over a 12-month follow-up, significant differences were noted regarding exacerbation rates and treatment tolerability. Notably, regimens incorporating early combination therapy with inhaled corticosteroids (ICS) and long-acting β₂-agonists (LABA) showed a faster improvement in lung function and a reduced risk of severe exacerbations compared with protocols relying on sequential escalation of monotherapy. These findings suggest that early introduction of combination therapy may be advantageous in achieving rapid asthma control and preventing exacerbations in children with moderate-to-severe disease. The study supports a tailored, patient-centered approach in managing pediatric asthma, emphasizing both efficacy and safety.

Bronchial asthma, pediatric asthma, stepwise treatment, inhaled corticosteroids, long-acting β₂-agonists, asthma control, comparative effectiveness.

Global Initiative for Asthma (GINA). (2021). GINA Report: Global Strategy for Asthma Management and Prevention. Available at: https://ginasthma.org

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