Abstract Childhood asthma affects 1 in 7 children; its prevalence has increased since 1970 but it is now declining. We understand the basic pathology but are not able to modify the natural course of the disease. Sixty per cent of asthma in adults has its origin in childhood. Longitudinal studies assessing lung function from early childhood into adult life indicate that airways obstruction is present in early childhood. This ‘remodelling’ indicates that if we are to influence the natural history of the disease, many more studies will be needed in very young children. Most asthma in children can be fully managed in primary care. Inhaled corticosteroids in low doses remain the cornerstone of prevention therapy. Guideline management is well established and should be followed, but more studies are needed in children where the evidence-base is still poor. Most acute asthma episodes are caused by viral infections, particularly rhinoviral infections. Understanding this organism will go a long way in planning how to prevent exacerbations in the future. Exacerbations in childhood remain common, causing major disruptions within families, high numbers of hospital admissions and significant school absenteeism. Many children are still prescribed inhalers which they cannot use; there is a lack of training, information and education within families. Simple practical measures could make strides forward in improving asthma control and reducing the burden of the disease. Care plans need developing across the primary/secondary care interface so that healthcare professionals and families have up-to-the-minute information enabling optimal control of symptoms.