The aim of this study is to evaluate the latest data on the administration of pre-school children with wheeze and asthma and propose a phénotype-based strategy to child management. Recent studies have begun to identify populations of pre-school kids who are likely to benefit from ICS and defined ICS therapy: daily ICS in pre-school kids with continued asthma and pre-emptive high dose intermittent ICS in preschool kids with intermittent illness minimize the likelihood of exacerbation. Furthermore, in preschool children with moderate persistent asthma, the presence of aeroallergen sensitivity and/or blood eosinophil levels of 300/L or higher predicts a favourable response to daily ICS treatment. The relevance of oral corticosteroids (OCS) as a treatment for acute exacerbations remains questionable, since a recent meta-analysis found that OCS did not reduce the need for hospitalizations or urgent visits, nor did it lessen the need for further rounds of OCS. Whereas previous epidemiologic studies suggested that acetaminophen may increase the risk of exacerbations, a clinical trial clearly demonstrated that acetaminophen use, when compared to ibuprofen use, does not increase the risk of exacerbation in preschool children with mild-to-moderate persistent asthma.

Recent research has demonstrated that phenotypic-driven treatments have the potential to improve the management of preschool children with asthma. Airway bacteria targeting has emerged as a viable therapeutic strategy, but its impact on antibiotic resistance has to be studied further. Finally, further research is needed to determine if oral corticosteroids are beneficial for acute episodic wheezing.