**4. Status and purpose**

Additionally, accumulating evidence has indicated an abnormal increase in the number and size of microvessels within bronchial tissue in remodeled airways [21]. This occurs mainly below the basal lamina, in the space between the muscle layer and the surrounding paren‐ chyma [21]. An imbalance between vascular endothelial growth factor (VEGF) and angiopoie‐ tin-1 has been shown to be involved in these abnormalities [21]. In fact, VEGF acts by increasing the permeability of these abnormal blood vessels, resulting in vessel dilation and edema, which contribute to airway narrowing [21, 22]. In addition to providing nutrition to the airways, these vessels are the source of inflammatory cells and plasma-derived mediators and cytokines [21].

The optimal treatment of childhood asthma depends upon a number of factors, including the child's age, the severity and frequency of asthma attacks, and the ability to properly use the prescribed medications [2]. For the vast majority of children, asthma treatment can control symptoms, allowing the child to participate fully in all activities, including sports. Identifying and avoiding asthma triggers, the factors that set off or worsen asthma symptoms, are essential for preventing asthma flare-ups [2]. Common asthma triggers generally include allergens (such as dust, pollen, and furred animals), respiratory infections, irritants (such as tobacco smoke, chemicals, and strong odors or fumes), physical activity, certain medicines (such as beta blockers, aspirin, or other nonsteroidal anti-inflammatory medications), and emotional stress [2]. After identifying potential triggers of asthma, the parent and health care provider should develop a plan to deal with the triggers. If possible, the child should completely avoid

The long-term goals of asthma management are to achieve good symptom control and to minimize future risk of exacerbation, fixed airflow limitation, and side effects of treatment [2]. In control-based asthma management, pharmacological and nonpharmacological treatment is adjusted continuously in a cycle that involves assessment, treatment, and review of the response [2]. Asthma severity is determined by considering the following factors: the symp‐ toms reported over the previous 2 to 4 weeks, the current level of lung function (FEV1 and FEV1/FVC values), and the number of instances of exacerbation requiring oral glucocorticoids per year [2]. The classification of severity in children aged 5–11 years or in adolescents over the age of 12 years is similar to that in adults [2]. The severity in children under the age of 4 years, however, is classified somewhat differently and includes intermittent, mild persistent,

Medication for asthma is mainly divided into two categories: controller medications and reliever (rescue) medications [2]. Controller medications, such as inhaled corticosteroids (ICS) and long-acting beta-adrenoceptor agonists (LABA), are used for regular maintenance treatment [24–26]. These medications reduce airway inflammation, control symptoms, and reduce future risks, such as exacerbations and decreased lung function. Reliever medications,

**3. Conventional treatment of childhood asthma**

or limit exposure to the trigger [2].

222 Asthma - From Childhood Asthma to ACOS Phenotypes

moderate persistent, and severe persistent asthma [2].

**3.1. Categories of asthma medications**

Currently, according to the guidelines published by the Global Initiative for Asthma (GINA), conventional medicines are the mainstay for managing asthma; these include steroids, beta-2 adrenergic agonists, leukotriene modifiers, theophylline, and anti-IgE therapies [2]. However, current conventional medications for childhood asthma are not yet satisfactory. The side effects of long-term use of steroids and beta-2 adrenergic agonists are major concerns for parents, in that growth, bone turnover, and adrenal gland function may be suppressed under, particularly higher doses of steroids [24, 25]. Due to the chronic and potentially life-threatening nature of asthma, and the lack of definitive preventive and curative therapies, many families look to complementary and alternative medicine (CAM) for treatment. CAM is popular in the treatment of asthma and encompasses many therapies, including mind–body techniques, nutritional manipulation, dietary and herbal supplements, TCM (including acupuncture), exercise, manual therapies, and homeopathy [26]. Reportedly, CAM is commonly used in children who have mild or moderate persistent asthma, those receiving high-dose ICS, and patients who experience poor symptom control or require frequent physician visits, including emergency room visits [26]. One retrospective longitudinal cohort study showed that initiation of CAM treatment does not decrease future adherence to conventional asthma medications, suggesting that alternative or integrative medicine use does not necessarily compete with conventional asthma therapies [27]. As CAM use becomes more prevalent, it will become increasingly important for physicians attending to asthmatic children to be aware of CAM use. TCM is the major component of CAM therapies used in the United States and Taiwan. TCM is one of the oldest medical practices in the world and has played an important role in preventing and treating diseases in China for centuries, where it is still used as a monotherapy or as part of an integrated medicine approach. Evidence has increased showing the efficacy of TCM for the treatment of childhood asthma. Below, we explore complementary therapy, involving TCM therapy for childhood asthma.
