Controversies in the Management of Preschool Asthma.

Abstract

Preschool asthma-one of the most common pediatric conditions-continues to spark significant debate around its management. In this article, we critically examine controversies in preschool asthma management by focusing on definition, diagnosis, management goals, acute and routine management, patient advocacy, and care coordination. We address controversial questions around the definition of preschool asthma, the role of biomarkers, the efficacy of oral corticosteroids in preschool asthma attacks, the use of maintenance inhaled corticosteroids, the use of montelukast, and the possible use of targeted antibiotics. Furthermore, we emphasize the critical role of structured preschool asthma management plans and the involvement of nursery teachers and nurses in optimizing preschool asthma care. Overall, our review supports a shift toward individualized treatment strategies and improved health care coordination. Future research should prioritize the validation of predictive biomarkers to refine individualized treatment decisions that will be evaluated against patient-reported outcomes. To this direction, we make suggestions about the development and validation of biomarkers and different approaches in clinical trials design.