Assessing and addressing suboptimal adherence to asthma medications is a key component in the treatment of all children with asthma, particularly those with difficult‐to‐treat asthma. However, parents often overreport adherence to asthma medications. Increased medication adherence could lead to improved outcomes in the form of better asthma control and decreased asthma exacerbations, as well as decreased healthcare utilization costs. Yet there are many complex factors that affect medication adherence, and barriers are often different in each family. Social determinants of health, complex healthcare relationships, and patient‐related factors may all affect medication adherence. Multicomponent patient‐centered strategies, as well as strategies that utilize technology and habit formation strategies may be helpful in improving medication adherence. Further study is needed to reliably and sustainably improve medication adherence in children with asthma across the broader population; in some populations, alternate diagnoses, adjusting therapy, and other intervention may be required to improve asthma control and health.

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Objective: Asthma disproportionately impacts youth who have been systemically marginalized and underserved, henceforth termed underserved for brevity. Disparities are previously published, presented, or disseminated.

An estimated 7 million children in the United States have asthma, which causes a significant health care burden and affects quality of life. The minority of these children have asthma that does not respond to Global Initiative for Asthma steps 4 and 5 care, and biological medications are recommended at this level in the 2019 Global Initiative for Asthma recommendations. In addition, biologics have been introduced into the care of children with allergic skin diseases. Omalizumab and mepolizumab are approved for children as young as 6 years, and benralizumab and dupilumab are approved for people aged $12 years. Reslizumab is approved only for people aged $18 years. These monoclonal antibodies may be added for appropriate patients when asthma or allergic skin diseases are not well controlled. Pediatricians and pediatric subspecialists should work together and be aware of the benefits and risks of these medications for their patients, as well as the practical implications of providing these options for their patients. This clinical report serves as an evaluation of the current literature on these types of medications in the treatment of children with asthma and allergic skin disease. ASTHMAAsthma may not be controlled in 38% of affected children, and biological medications may be prescribed if appropriate, other pharmacologic treatment, treatment of comorbidities, and verification of medication adherence does not lead to an acceptable level of control. 1 The minority of these children have asthma that does not respond to Global Initiative for Asthma (GINA) steps 4 and 5 care, and biological medications are recommended at this level in the 2019 GINA recommendations. 2 It is important to first confirm the diagnosis of asthma and to verify adherence to and appropriate technique for using an inhaler before embarking on biological therapy. Limited numbers of clinical trials include children, resulting in minimal current information on biological use in the pediatric population. The exception is the oldest biological therapy, omalizumab,