As the most common chronic disease of childhood, asthma is the primary reason kids are admitted to hospitals. Children’s Hospital of Philadelphia (CHOP) is committed to improving pediatric asthma outcomes for local communities and around the world, offering pulmonary care ranked best in the nation.
Rooted in compassion, CHOP delivers care that spans patient education, advanced therapies, personalized treatment plans, community engagement, and ongoing support — all with the goal of enabling children and families to take control of asthma.
Shikha Saxena, MD is an attending physician for CHOP’s Division of Pulmonary and Sleep Medicine, the director of the Pulmonary Asthma Program, and the co-director of the Pulmonology and Allergy Personalized Asthma (PAPA) Clinic. She recently shared insights about CHOP’s multidisciplinary approach to diagnosis, management strategies, and family-centered care, and how the team ensures all children have access to the treatment they need.
Dr. Saxena’s Start in Pediatric Asthma Care
What sparked your interest in pediatric asthma care?
Dr. Saxena: From a young age, I understood how breathing problems can impact daily life. As a child with asthma, I spent many days in my own doctor’s office undergoing spirometry, trying new inhalers, and learning how to manage symptoms that would otherwise interfere with my ability to go to sleepovers or field trips.
During medical training, I found myself drawn to the physiology of the respiratory system and to patients with breathing challenges. Asthma, the most common respiratory disease of childhood, stood out to me because of its significant burden on children and their families. I also saw that, with the right medications and education, asthma can be kept under control, allowing a child to fully participate in the activities that matter to them.
Over time, our understanding of asthma pathophysiology, diagnosis, and treatment continues to evolve. Now, as a pediatric pulmonologist, I find it very exciting and rewarding to care for children with asthma and to apply the latest developments in the field to help my patients live and breathe better.
Clinical Management, Treatment Strategies, and Education
In addition to asthma medication, what are some key strategies to improve asthma control?
Dr. Saxena: Medications are critical for asthma control, but if they’re not taken correctly or regularly, they may not be effective. We spend a lot of time providing education on the proper inhaler technique. For example, using a valved holding chamber or spacer with a metered-dose inhaler helps the inhaled medication move past the mouth and settle deep into the lungs, where it is needed to work.
We also address other health problems (e.g., allergic rhinitis, gastroesophageal reflux, obstructive sleep apnea, immunodeficiency, or obesity) or environmental exposures (e.g., secondhand smoke, air pollution, or dust) that may contribute to asthma symptoms.
We often pursue further diagnostic workup including labs, imaging, and pulmonary function tests to ensure the correct diagnosis. Additionally, certain test results (e.g., serum eosinophils, immunoglobulin E, and fractional exhaled nitric oxide) help us understand that patient’s type of asthma (known as a phenotype or endotype) and tailor our therapies accordingly.
How do you educate families about recognizing early warning signs and preventing asthma exacerbations?
Dr. Saxena: Educating families about asthma exacerbations is essential so they can respond quickly and effectively. I listen closely as they describe past flares to identify triggers and early symptoms. Many families also share videos to help us recognize concerning sounds like wheezing or a bronchospastic cough.
Together, we develop a treatment plan that addresses the child’s chronic and acute symptoms. Every patient then receives a personalized, color‑coded asthma action plan. We review and update the plan at every visit to make sure it’s working well. We also provide a copy for the school.
An asthma action plan is only useful if patients have access to the medications they need. Because sometimes there are challenges in insurance coverage or pharmacy availability, I encourage families to bring their inhalers to medical visits so we can confirm that they are correct and not empty or expired. Our nurses and pharmacists help troubleshoot access issues by arranging refills, coordinating with mail-order pharmacies, and submitting prior authorization requests.
How do you address psychosocial challenges, such as anxiety or school-related issues, that may affect asthma control?
Dr. Saxena: Children with asthma may experience psychosocial difficulties and are at greater risk for anxiety and depression compared to children without asthma. Anxiety and depression are also linked to worse asthma control. This may be because emotional stress can act as a trigger for asthma symptoms, and mental health problems can reduce an individual’s medication adherence or ability to recognize and treat symptoms. Children with asthma may also experience negative psychosocial effects from missing out on school, recess, or sports.
Our multidisciplinary asthma program is fortunate to have support from social workers and psychologists. Our dedicated asthma social workers meet with families during visits and communicate closely with them between visits to help address social barriers to care. Our psychologists from CHOP's Department of Child and Adolescent Psychiatry and Behavioral Sciences (DCAPBS) meet with patients to provide counseling and help facilitate long-term therapy when needed. Our team will also speak directly with school nurses and provide paperwork for patients to receive the care and accommodations they need at school.
When do you consider adding a biologic agent, and how do you counsel families before starting biologic therapy?
Dr. Saxena: Biologic therapy may be recommended for patients with severe asthma — defined as asthma that remains uncontrolled despite high-dose inhaled corticosteroids and long-acting beta agonists after confirming proper medication use, managing comorbidities, and reducing exposures. Biologics can reduce symptoms and exacerbations, improve lung function, and enhance quality of life by targeting specific inflammatory pathways. Clinical trials show that they are very effective and safe when used correctly.
When considering a biologic, I discuss the benefits and possible side effects with families. Several options are approved for children and adolescents, and we use shared decision-making to choose the best fit based on type of asthma, age, comorbidities, side effects, and dosing frequency. I explain that full therapeutic benefit may take 4-6 months, and that regular inhalers should be continued.
Biologics are given by subcutaneous injection every 2-8 weeks. To ensure families feel confident giving the injections at home, they receive thorough education in-clinic or through the Family Learning Center. Most families describe biologic therapy as a “game-changer,” with patients feeling much better once established on the treatment.
When do you recommend referring a pediatric patient to a specialized severe asthma clinic?
Dr. Saxena: We’re happy to see any asthma patient for further subspecialty evaluation. Our goal is to adequately control symptoms and prevent exacerbations by utilizing the least amount of medication possible.
Consider referral for patients with:
- Frequent hospitalizations for asthma exacerbation, including admission to the intensive care unit
- Multiple courses of oral corticosteroids
- History of intubation for asthma
- Overuse of rescue inhaler
- Underuse of controller inhaler
Our asthma program offers:
- Specialized testing to confirm the diagnosis of asthma and evaluate for other pulmonary disorders — evaluation may include labs, imaging, pulmonary function testing, sweat testing, sleep study, and bronchoscopy
- Assistance in escalating or deescalating maintenance therapy based on current evidence-based guidelines
- Consideration and initiation of biologic therapy
- Evaluation for medication side effects
- Patient and family-centered education and psychosocial support
Multidisciplinary Collaboration and Community Engagement for Better Outcomes
How do you collaborate with primary care providers, pulmonologists, allergists, and other specialists to optimize patient outcomes?
Dr. Saxena: It’s important for us to maintain close communication with the other providers on a patient’s treatment team. Our pulmonary clinic visit notes containing our recommendations are sent to the primary care provider after each visit. We’re also available for direct communication if needed, for example during periods of poor asthma control or during an acute exacerbation.
We also offer a multidisciplinary program called the Pulmonology and Allergy Personalized Asthma (PAPA) clinic for patients with severe or difficult-to-treat asthma. This clinic involves a pulmonologist, allergist, nurse, social worker, and psychologist who collaborate closely with one another, the patient, and the family. Children who participate in this program have experienced a reduction in asthma-related emergency room visits and hospitalizations.
What is CHOP doing to improve outcomes for children with asthma?
Dr. Saxena: CHOP strives to improve asthma care from multiple perspectives:
Patient, family, and provider education
CHOP has recently rolled out new bedside education materials for patients and families to review prior to discharge from an asthma hospitalization. This involves an online, interactive module as well as personalized training by a nurse or respiratory therapist on the asthma care plan. We have also reviewed and updated over 40 asthma education articles and videos for our Epic Teaching Library. We give lectures to primary care practices and hospitals in the area on the latest evidence-based asthma guidelines.
Care coordination
We help smooth the transition from inpatient to outpatient care in many ways. We ensure families have their prescribed medications in hand prior to discharge. We provide inpatient consultation, seeing children when they are hospitalized for asthma and communicating closely with the primary team and primary pulmonologist. Our coordinators use an informatics dashboard to keep track of patients who have been admitted for an asthma exacerbation and prioritize them in the pulmonary or allergy clinic schedule to be seen within a month of discharge.
Quality improvement
Quality improvement projects allow us to push the standard of care forward for asthma.
- The Asthma Population Health Workup is a multidisciplinary team that drives many of the quality improvement projects at CHOP, particularly those aimed at reducing emergency department and hospitalization visits for asthma.
- The primary care team is using clinical decision support to implement the latest evidence-based guidelines in the asthma field, including Single Maintenance and Reliever Therapy (SMART).
- The Emergency Department is increasing prescriptions of inhaled corticosteroid inhalers for patients with uncontrolled asthma to help reduce their risk of asthma flares.
- The pulmonary and allergy divisions are working closely with the Pediatric Intensive Care Unit to provide consultations for children admitted with status asthmaticus to optimize maintenance therapy and facilitate outpatient follow-up.
- The pharmacy has a new initiative to provide home delivery of controller medications after asthma discharge.
Community outreach
Even outside of the clinic and hospital, our team is working hard to improve asthma care. CHOP’s Community Asthma Prevention Program (CAPP) leans on community health workers and nurse care managers who conduct home visits and perform counseling in the home. There’s also a home repair program to help support families looking to keep a safe and healthy environment for their children, free from pests and mold. Finally, the parent tobacco treatment platform connects caregivers to smoking cessation resources, and the Adolescent Specialized Treatment and Recovery Team treats adolescents who use tobacco/nicotine products including vapes.
The Future of Pediatric Asthma Care and CHOP’s Leading Role
How do you believe pediatric asthma management will change over the next 25 years?
Dr. Saxena: We are fortunate to treat pediatric asthma during a period of rapid advancement in management. Over the past decade, several biologic therapies have been approved for moderate to severe persistent asthma in children and adolescents. These therapies target specific biomarkers identified through bloodwork, marking significant progress in precision medicine.
In the next 25 years, we can expect further progress toward personalized medicine, with the discovery of new biomarkers, identification of genetic risk factors, and the expansion of targeted biologic therapies. Ideally, the age of approval for these therapies will decrease, allowing for earlier initiation of steroid-sparing treatments. Preventative use in young children at high risk for developing asthma may also become possible.
Future management will likely address a broader range of asthma phenotypes and endotypes, beyond those characterized by type 2 inflammation. While biologics are currently adjunctive to inhaler therapy, we may eventually simplify treatment regimens to fewer, more effective medications. Additionally, research will clarify the long-term benefits of biologics, including the potential for asthma remission.
What’s your vision for the future of CHOP’s Asthma Program?
Dr. Saxena: My goal is to position CHOP as a leader in delivering personalized, innovative, and compassionate asthma care. Our multidisciplinary team will continue to provide evidence-based treatment and meet regularly to review emerging clinical trials and guidelines. We will continue to enhance the patient and family experience by prioritizing education, patient comfort, and communication with the healthcare team. Our goal is for every family to have a positive healthcare experience and feel supported throughout their journey.
We are committed to expanding access to advanced diagnostics and treatments across Philadelphia and our satellite locations. Recent updates, such as incorporating fractional exhaled nitric oxide testing, allow us to better identify airway inflammation and evaluate candidates for biologic therapy. We’re also starting to offer biologic administration at satellite sites, reducing travel burden, and promoting equity for families across the area.
CHOP will continue to play an active role in the medical community. We will strengthen collaborations with other institutions to study patterns in asthma management and outcomes, and we will continue to present our work at local and international conferences. In this way, we can advance pediatric asthma care and improve the lives of children with asthma beyond the walls of our institution.
Is there anything else you think patients or referring physicians should know about you and your approach to care?
Dr. Saxena: Caring for children with asthma is truly my passion, and I look forward to partnering with their families and pediatricians each day. Effective asthma care goes beyond prescribing an inhaler — it means guiding families to recognize symptoms, avoid environmental triggers, and incorporate the treatment regimen into daily life at home, school, and activities. In this process, I strive to be a steady, reassuring presence while equipping patients with the tools and confidence they need to prevent future episodes. Ultimately, my goal is to help children breathe comfortably, play freely, and grow into healthy adults without asthma holding them back.
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As the most common chronic disease of childhood, asthma is the primary reason kids are admitted to hospitals. Children’s Hospital of Philadelphia (CHOP) is committed to improving pediatric asthma outcomes for local communities and around the world, offering pulmonary care ranked best in the nation.
Rooted in compassion, CHOP delivers care that spans patient education, advanced therapies, personalized treatment plans, community engagement, and ongoing support — all with the goal of enabling children and families to take control of asthma.
Shikha Saxena, MD is an attending physician for CHOP’s Division of Pulmonary and Sleep Medicine, the director of the Pulmonary Asthma Program, and the co-director of the Pulmonology and Allergy Personalized Asthma (PAPA) Clinic. She recently shared insights about CHOP’s multidisciplinary approach to diagnosis, management strategies, and family-centered care, and how the team ensures all children have access to the treatment they need.
Dr. Saxena’s Start in Pediatric Asthma Care
What sparked your interest in pediatric asthma care?
Dr. Saxena: From a young age, I understood how breathing problems can impact daily life. As a child with asthma, I spent many days in my own doctor’s office undergoing spirometry, trying new inhalers, and learning how to manage symptoms that would otherwise interfere with my ability to go to sleepovers or field trips.
During medical training, I found myself drawn to the physiology of the respiratory system and to patients with breathing challenges. Asthma, the most common respiratory disease of childhood, stood out to me because of its significant burden on children and their families. I also saw that, with the right medications and education, asthma can be kept under control, allowing a child to fully participate in the activities that matter to them.
Over time, our understanding of asthma pathophysiology, diagnosis, and treatment continues to evolve. Now, as a pediatric pulmonologist, I find it very exciting and rewarding to care for children with asthma and to apply the latest developments in the field to help my patients live and breathe better.
Clinical Management, Treatment Strategies, and Education
In addition to asthma medication, what are some key strategies to improve asthma control?
Dr. Saxena: Medications are critical for asthma control, but if they’re not taken correctly or regularly, they may not be effective. We spend a lot of time providing education on the proper inhaler technique. For example, using a valved holding chamber or spacer with a metered-dose inhaler helps the inhaled medication move past the mouth and settle deep into the lungs, where it is needed to work.
We also address other health problems (e.g., allergic rhinitis, gastroesophageal reflux, obstructive sleep apnea, immunodeficiency, or obesity) or environmental exposures (e.g., secondhand smoke, air pollution, or dust) that may contribute to asthma symptoms.
We often pursue further diagnostic workup including labs, imaging, and pulmonary function tests to ensure the correct diagnosis. Additionally, certain test results (e.g., serum eosinophils, immunoglobulin E, and fractional exhaled nitric oxide) help us understand that patient’s type of asthma (known as a phenotype or endotype) and tailor our therapies accordingly.
How do you educate families about recognizing early warning signs and preventing asthma exacerbations?
Dr. Saxena: Educating families about asthma exacerbations is essential so they can respond quickly and effectively. I listen closely as they describe past flares to identify triggers and early symptoms. Many families also share videos to help us recognize concerning sounds like wheezing or a bronchospastic cough.
Together, we develop a treatment plan that addresses the child’s chronic and acute symptoms. Every patient then receives a personalized, color‑coded asthma action plan. We review and update the plan at every visit to make sure it’s working well. We also provide a copy for the school.
An asthma action plan is only useful if patients have access to the medications they need. Because sometimes there are challenges in insurance coverage or pharmacy availability, I encourage families to bring their inhalers to medical visits so we can confirm that they are correct and not empty or expired. Our nurses and pharmacists help troubleshoot access issues by arranging refills, coordinating with mail-order pharmacies, and submitting prior authorization requests.
How do you address psychosocial challenges, such as anxiety or school-related issues, that may affect asthma control?
Dr. Saxena: Children with asthma may experience psychosocial difficulties and are at greater risk for anxiety and depression compared to children without asthma. Anxiety and depression are also linked to worse asthma control. This may be because emotional stress can act as a trigger for asthma symptoms, and mental health problems can reduce an individual’s medication adherence or ability to recognize and treat symptoms. Children with asthma may also experience negative psychosocial effects from missing out on school, recess, or sports.
Our multidisciplinary asthma program is fortunate to have support from social workers and psychologists. Our dedicated asthma social workers meet with families during visits and communicate closely with them between visits to help address social barriers to care. Our psychologists from CHOP's Department of Child and Adolescent Psychiatry and Behavioral Sciences (DCAPBS) meet with patients to provide counseling and help facilitate long-term therapy when needed. Our team will also speak directly with school nurses and provide paperwork for patients to receive the care and accommodations they need at school.
When do you consider adding a biologic agent, and how do you counsel families before starting biologic therapy?
Dr. Saxena: Biologic therapy may be recommended for patients with severe asthma — defined as asthma that remains uncontrolled despite high-dose inhaled corticosteroids and long-acting beta agonists after confirming proper medication use, managing comorbidities, and reducing exposures. Biologics can reduce symptoms and exacerbations, improve lung function, and enhance quality of life by targeting specific inflammatory pathways. Clinical trials show that they are very effective and safe when used correctly.
When considering a biologic, I discuss the benefits and possible side effects with families. Several options are approved for children and adolescents, and we use shared decision-making to choose the best fit based on type of asthma, age, comorbidities, side effects, and dosing frequency. I explain that full therapeutic benefit may take 4-6 months, and that regular inhalers should be continued.
Biologics are given by subcutaneous injection every 2-8 weeks. To ensure families feel confident giving the injections at home, they receive thorough education in-clinic or through the Family Learning Center. Most families describe biologic therapy as a “game-changer,” with patients feeling much better once established on the treatment.
When do you recommend referring a pediatric patient to a specialized severe asthma clinic?
Dr. Saxena: We’re happy to see any asthma patient for further subspecialty evaluation. Our goal is to adequately control symptoms and prevent exacerbations by utilizing the least amount of medication possible.
Consider referral for patients with:
- Frequent hospitalizations for asthma exacerbation, including admission to the intensive care unit
- Multiple courses of oral corticosteroids
- History of intubation for asthma
- Overuse of rescue inhaler
- Underuse of controller inhaler
Our asthma program offers:
- Specialized testing to confirm the diagnosis of asthma and evaluate for other pulmonary disorders — evaluation may include labs, imaging, pulmonary function testing, sweat testing, sleep study, and bronchoscopy
- Assistance in escalating or deescalating maintenance therapy based on current evidence-based guidelines
- Consideration and initiation of biologic therapy
- Evaluation for medication side effects
- Patient and family-centered education and psychosocial support
Multidisciplinary Collaboration and Community Engagement for Better Outcomes
How do you collaborate with primary care providers, pulmonologists, allergists, and other specialists to optimize patient outcomes?
Dr. Saxena: It’s important for us to maintain close communication with the other providers on a patient’s treatment team. Our pulmonary clinic visit notes containing our recommendations are sent to the primary care provider after each visit. We’re also available for direct communication if needed, for example during periods of poor asthma control or during an acute exacerbation.
We also offer a multidisciplinary program called the Pulmonology and Allergy Personalized Asthma (PAPA) clinic for patients with severe or difficult-to-treat asthma. This clinic involves a pulmonologist, allergist, nurse, social worker, and psychologist who collaborate closely with one another, the patient, and the family. Children who participate in this program have experienced a reduction in asthma-related emergency room visits and hospitalizations.
What is CHOP doing to improve outcomes for children with asthma?
Dr. Saxena: CHOP strives to improve asthma care from multiple perspectives:
Patient, family, and provider education
CHOP has recently rolled out new bedside education materials for patients and families to review prior to discharge from an asthma hospitalization. This involves an online, interactive module as well as personalized training by a nurse or respiratory therapist on the asthma care plan. We have also reviewed and updated over 40 asthma education articles and videos for our Epic Teaching Library. We give lectures to primary care practices and hospitals in the area on the latest evidence-based asthma guidelines.
Care coordination
We help smooth the transition from inpatient to outpatient care in many ways. We ensure families have their prescribed medications in hand prior to discharge. We provide inpatient consultation, seeing children when they are hospitalized for asthma and communicating closely with the primary team and primary pulmonologist. Our coordinators use an informatics dashboard to keep track of patients who have been admitted for an asthma exacerbation and prioritize them in the pulmonary or allergy clinic schedule to be seen within a month of discharge.
Quality improvement
Quality improvement projects allow us to push the standard of care forward for asthma.
- The Asthma Population Health Workup is a multidisciplinary team that drives many of the quality improvement projects at CHOP, particularly those aimed at reducing emergency department and hospitalization visits for asthma.
- The primary care team is using clinical decision support to implement the latest evidence-based guidelines in the asthma field, including Single Maintenance and Reliever Therapy (SMART).
- The Emergency Department is increasing prescriptions of inhaled corticosteroid inhalers for patients with uncontrolled asthma to help reduce their risk of asthma flares.
- The pulmonary and allergy divisions are working closely with the Pediatric Intensive Care Unit to provide consultations for children admitted with status asthmaticus to optimize maintenance therapy and facilitate outpatient follow-up.
- The pharmacy has a new initiative to provide home delivery of controller medications after asthma discharge.
Community outreach
Even outside of the clinic and hospital, our team is working hard to improve asthma care. CHOP’s Community Asthma Prevention Program (CAPP) leans on community health workers and nurse care managers who conduct home visits and perform counseling in the home. There’s also a home repair program to help support families looking to keep a safe and healthy environment for their children, free from pests and mold. Finally, the parent tobacco treatment platform connects caregivers to smoking cessation resources, and the Adolescent Specialized Treatment and Recovery Team treats adolescents who use tobacco/nicotine products including vapes.
The Future of Pediatric Asthma Care and CHOP’s Leading Role
How do you believe pediatric asthma management will change over the next 25 years?
Dr. Saxena: We are fortunate to treat pediatric asthma during a period of rapid advancement in management. Over the past decade, several biologic therapies have been approved for moderate to severe persistent asthma in children and adolescents. These therapies target specific biomarkers identified through bloodwork, marking significant progress in precision medicine.
In the next 25 years, we can expect further progress toward personalized medicine, with the discovery of new biomarkers, identification of genetic risk factors, and the expansion of targeted biologic therapies. Ideally, the age of approval for these therapies will decrease, allowing for earlier initiation of steroid-sparing treatments. Preventative use in young children at high risk for developing asthma may also become possible.
Future management will likely address a broader range of asthma phenotypes and endotypes, beyond those characterized by type 2 inflammation. While biologics are currently adjunctive to inhaler therapy, we may eventually simplify treatment regimens to fewer, more effective medications. Additionally, research will clarify the long-term benefits of biologics, including the potential for asthma remission.
What’s your vision for the future of CHOP’s Asthma Program?
Dr. Saxena: My goal is to position CHOP as a leader in delivering personalized, innovative, and compassionate asthma care. Our multidisciplinary team will continue to provide evidence-based treatment and meet regularly to review emerging clinical trials and guidelines. We will continue to enhance the patient and family experience by prioritizing education, patient comfort, and communication with the healthcare team. Our goal is for every family to have a positive healthcare experience and feel supported throughout their journey.
We are committed to expanding access to advanced diagnostics and treatments across Philadelphia and our satellite locations. Recent updates, such as incorporating fractional exhaled nitric oxide testing, allow us to better identify airway inflammation and evaluate candidates for biologic therapy. We’re also starting to offer biologic administration at satellite sites, reducing travel burden, and promoting equity for families across the area.
CHOP will continue to play an active role in the medical community. We will strengthen collaborations with other institutions to study patterns in asthma management and outcomes, and we will continue to present our work at local and international conferences. In this way, we can advance pediatric asthma care and improve the lives of children with asthma beyond the walls of our institution.
Is there anything else you think patients or referring physicians should know about you and your approach to care?
Dr. Saxena: Caring for children with asthma is truly my passion, and I look forward to partnering with their families and pediatricians each day. Effective asthma care goes beyond prescribing an inhaler — it means guiding families to recognize symptoms, avoid environmental triggers, and incorporate the treatment regimen into daily life at home, school, and activities. In this process, I strive to be a steady, reassuring presence while equipping patients with the tools and confidence they need to prevent future episodes. Ultimately, my goal is to help children breathe comfortably, play freely, and grow into healthy adults without asthma holding them back.
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Division of Pulmonary and Sleep Medicine