Preschool asthma remains one of the most frequently encountered and challenging conditions in pediatric medicine and a new study explores the growing list of controversies surrounding its management. The article highlights significant areas of disagreement including the definition of asthma in young children, diagnostic criteria, treatment strategies, and the use of pharmacologic therapies.
The study examines major clinical decision points in managing preschool asthma and reveals how fragmented current approaches can be. The authors address questions about the reliability of biomarkers in early diagnosis, the controversial use of oral corticosteroids during acute episodes, and the debated effectiveness of maintenance inhaled corticosteroids and montelukast. They also explore the emerging conversation around the potential role of targeted antibiotics.
Beyond pharmacologic considerations, the article emphasizes the need for structured asthma management plans and broader coordination across caregivers. It highlights the often-overlooked role of nursery staff such as teachers and nurses in delivering effective day-to-day asthma care. This underscores a wider shift in thinking, moving away from rigid protocols toward personalized care tailored to each child’s clinical profile.
The authors argue that the future of preschool asthma care lies in validating predictive biomarkers that can guide more individualized treatment strategies. These approaches must be weighed not just against clinical outcomes but also against what matters most to families, patient-reported experiences and quality of life.
As the field awaits more conclusive evidence, this review calls for a unified effort in refining definitions, improving diagnostic accuracy, and strengthening healthcare coordination. It serves as both a call to action and a roadmap for clinicians managing asthma in children under five.
Reference:
Makrinioti H et al. Controversies in the Management of Preschool Asthma. JACI. 2025. https://doi.org/10.1016/j.jaip.2025.04.057.
