Although evidence was considered for children aged 4–11 years, current formulations are licensed for children aged ≥6 years; hence, the recommendation is restricted to children aged 6–11 years.

• Current evidence supports the use of combination inhaler (steroid plus fast-onset long-acting beta2 agonist) MART for children with persistent asthma symptoms who are already taking or planning to start regular ICS therapy.
• The use of a combination inhaler results in a potentially simpler regime, which may be more easily followed by both patients and prescribers (143).
• Children with infrequent symptoms should use short-acting beta2 agonist (SABA) as needed, considering the concomitant intermittent use of ICS.
• The importance of ensuring that all asthma medicines, whether for reliever or maintenance therapy, are delivered by an appropriate inhaler device, considering the child’s age and preference.
• Where treatment is given using an MDI, it is essential that spacer devices are available to enhance delivery of the medicine into the lungs.
• In the absence of commercial spacer devices, a 500 mL bottle spacer is an effective alternative but should be constructed following the methods that have been demonstrated as effective (59).
• For both metered-dose and dry-powder inhalers, careful explanation and regular review of inhaler technique are vital.
• Successful adoption of a new approach to asthma management would require comprehensive training of health care providers to ensure competence to prescribe appropriately and educate patients and their families accordingly.
• Education on inhaler use, specific to the chosen delivery device, is an essential part of asthma management.