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Biologic therapy for asthma is not considered cost-effective based on current pricing structures. Manufacturers must seriously consider price reduction to provide fair value for biologic therapy. Practitioners should direct therapy only to responders to improve cost-effectiveness, including using biomarkers before initiating treatment and monitoring for response to treatment. A recent publication by the Global Initiative for Asthma provides an algorithmic approach to identifying adolescent and adult patients who can be considered candidates for biologic therapy. A recent Institute for Clinical and Economic Review report provides detailed information on available cost-effectiveness data and what is needed to improve cost-effectiveness of these treatments. Direct head-to-head studies of biologics are needed to adequately assess their comparative effectiveness.

Early identification of children with developmental delays is important in the primary care setting. The pediatrician is the best-informed professional with whom many families have contact during the first 5 years of a child's life. Parents look to the pediatrician to be the expert not only on childhood illnesses but also on development. Early intervention services for children from birth to 3 years of age and early childhood education services for children 3 to 5 years of age are widely available for children with developmental delays or disabilities in the United States. Developmental screening instruments have improved over the years, and instruments that are accurate and easy to use in an office setting are now available to the pediatrician. This statement provides recommendations for screening infants and young children and intervening with families to identify developmental delays and disabilities.

Symptomatic asthma in childhood has lifelong effects on lung function and disease severity, emphasizing the need for improved pediatric asthma control. Control of pediatric risk and impairment domains can be achieved through increased medication adherence or new therapeutic strategies. Developing electronic monitoring device technology with reminders might be a key noninvasive resource to address poor adherence in children and adolescents in a clinical setting. In patients who have persistently poor control despite optimal medication compliance, newly emerging pharmaceuticals, including inhaled therapies and biologics, might be key to their treatment. However, barriers exist to their development in the pediatric population, and insights must be drawn from adult studies, which has its own unique limitations. Biomarkers to direct the use of such potentially expensive therapies to those patients most likely to benefit are imperative. In this review the current literature regarding strategies to improve pediatric asthma control is addressed with the goal of exploring the potential and pitfalls of strategies that might be available in the near future.

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