Airway remodeling is when there are permanent physical changes to the airways that also affects how they work. This may happen after chronic long-term asthma. After cycles of inflammation, damage and repair to the airways. permanent remodeling of the airways may occur. This is when the physical structure of the airway changes. This will cause permanent airway narrowing (they are always more narrow than normal and get narrower during an asthma attack), bronchospasms are more easily triggered (bronchial hyperresponsivenes), airway edema (fluid in the airway), and mucus hypersecretion (too much mucous is made) as well as the build-up of collagen around the airway which is called fibrosis. Airway remodeling has been observed in chldren as young as six. 
The adverse effects of corticosteroids in pediatric patients are similar to those in adults (see ADVERSE REACTIONS ). Like adults, pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and osteoporosis. Pediatric patients who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity. This negative impact of corticosteroids on growth has been observed at low systemic doses and in the absence of laboratory evidence of HPA axis suppression (., cosyntropen stimulation and basal cortisol plasma levels). Growth velocity may therefore be a more sensitive indicator of systemic corticosteroid exposure in pediatric patients treated with corticosteroids should be monitored, and the potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the availability of treatment alternatives. In order to minimize the potential growth effects of corticosteroids, pediatric patients should be titrated to the lowest effective dose.
Endotracheal intubation and ventilation for impending respiratory failure:
Intubation and mechanical ventilation can be life-saving interventions but their use in paediatric patients with asthma have been associated with significant adverse effects. Up to 26% of children intubated due to asthma have complications, such as pneumothorax or impaired venous return, and cardiovascular collapse because of increased intrathoracic pressure  . Mechanical ventilation during an asthma exacerbation is associated with increased risk of death and should be considered as a last resort and only in conjunction with the support of a paediatric ICU specialist.