| Summary: | This editorial summarises the paediatric implications of the recent Lancet Asthma Commission, which has as a starting point that progress in asthma treatment has stalled. In summary, there were 7 recommendation. We must evolve from the use of umbrella terms to disease labels that allow for treatment guidelines to be more precise, specifically looking at the components of airway disease, extrapulmonary comorbidities and social and environmental factors and focussing on what is treatable. This is particularly relevant in pre-school wheeze, where the question should be, what asthma does my child have? We must move beyond a disease-control approach for asthma treatment and try to address the fundamental cause. We must emerge from age-associated and discipline associated silos and look at the developmental trajectories of airway disease. We must test before treatment and move away from our current ‘no-test’ culture. There should be zero tolerance for asthma attacks; they are not flare-ups or exacerbation, but a major warning sign of past failure and impending future disaster. We need to make the most of new treatment opportunities in severe disease, and importantly, match the biological to the endotype when such therapy is appropriate. Finally we need to carry out better research. Specifically, we need better characterisation of trial populations, moving beyond 'Dr-diagnosed asthma', and better animal models, reflecting the developmental reality of what we want to study. Overall, the aim of the Commission is to provoke a revolution in the way we think about airway disease.
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