MAIN UPDATES IN PEDIAT RIC ASTHMA MANAGEMENT ACCORDING TO GINA 2026: NEW PERSPECTIVES ON ANTI -INFLAMMATORY RELIEVER THERAPY AND EXACERBATION CONTROL /

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Introduction: Asthma is one of the most prevalent chronic diseases in childhood and remains a major cause of emergency visits, hospitalizations, and reduced quality of life worldwide. The 2026 update of the Global Initiative for Asthma (GINA) introduced important operational and therapeutic changes focused on reducing exacerbations and improving long - term inflammatory control in pediatric patients. Objective: To review the main updates in pediatric asthm a management proposed by the GINA 2026 strategy report, emphasizing anti-inflammatory reliever therapy, acute exacerbation management, and new assessment tools. Methods: This is a narrative literature review based on the analysis of the GINA 2026 Global Strategy for Asthma Management and Prevention report. The review focused on pediatric recommendations involving children and adolescents with asthma, including acute exacerbation protocols, anti -inflammatory reliever strategies, and severity assessment tools . Results: The GINA 2026 report introduced four new operational flowcharts for asthma exacerbation management according to age group and healthcare setting. Important updates include lower oxygen supplementation thresholds, more conservative use of short -acting beta2 -agonists (SABA), and the incorporation of inhaled corticosteroid - formoterol as an option for mild exacerbations in children aged 6 -11 years. The strategy also reinforced anti - inflammatory reliever therapy (AIR), recommending inhaled corticoste roids associated with bronchodilators to reduce severe exacerbations and future risks. Based on the CARE study, low -dose budesonide-formoterol used as needed reduced severe exacerbations by approximately 45% compared with isolated SABA use in pediatric pat ients. The Pediatric Respiratory Assessment Measure (PRAM) was strongly recommended for severity assessment during exacerbations. Additional updates included new biologic therapies, emphasis on inhaler technique, and reduction of cumulative oral corticosteroid exposure. Conclusion: The GINA 2026 recommendations represent an important shift in pediatric asthma management by prioritizing inflammatory control, exacerbation prevention, and individualized treatment strategies. The incorporation of anti -inflammatory reliever therapy and standardized assessment tools may contribute to safer and more effective asthma care in children and adolescents.