Objective:To explore the role of using methacholine challenge test（MCT）to detect airway responsiveness in standardized drug treatment management of asthma in children and adolescents.Methods:A total of 64 children diagnosed with moderate to severe persistent asthma from August 2010 to May 2021 at the Pediatric Asthma Clinic of the Second Hospital of Tianjin Medical University，who received standardized pharmacotherapy for 2 years，were selected and divided into a discontinued group（31 cases）and a continued group（33 cases）.The clinical value of lung function indicators，fractional exhaled nitric oxide（FeNO）values，and MCT results for evaluating and predicting the treatment effect of asthma in children and adolescents before and after treatment were analyzed.Results:The percentage of the expected value of forced expiratory volume in one second（FEV 1）before treatment discontinued group was higher than that in the continued group，and the difference was statistically significant（ F=7.283， P=0.009）.After standardized treatment for 6 months，1 year，and 2 years，the percentage of the expected value of FEV 1 in the discontinued group（ F=3.045， P=0.036）and continued group（ F=17.485， P<0.001）was significantly higher than that before treatment.There was no statistically significant difference in FeNO between the two groups before treatment（ F=0.298， P=0.587）.By treated for 6 months（ F=6.568， P=0.013），1 year（ F=4.317， P=0.042），and 2 years（ F=8.737， P=0.004），the FeNO levels of continued group were significantly higher than those of the discontinued group，with statistical significance.After treatment for 2 years，the PD 20 of the discontinued group was（1.702 ± 0.906）mg，while the PD 20 of the continued group was（1.184 ± 0.924）mg.The result was a significant difference between the two groups（ t=2.263， P=0.027）. Conclusion:Airway hyperresponsiveness of asthma patients persists，and the time for asthma to achieve clinical symptom control and inflammation improvement is earlier than that when airway responsiveness reaches the ideal level.In the long-term treatment and management of asthma，the clinical value of airway responsiveness assessment is relatively important.