In children aged 0-4 years with asthma, initial therapy commonly includes which regimen?

• A. PRN SABA & ICS with RTI
• B. High-Dose ICS/LABA
• C. Oral corticosteroids
• D. Immunotherapy

Answer: (A)

In preschool-aged children with asthma or episodic viral-induced wheeze, initial management often uses relief with a quick-acting bronchodilator plus anti-inflammatory therapy timed to infections. The idea is to keep the airway inflammation in check when it’s most likely to flare—during viral respiratory tract infections—without committing a child to daily high-dose inhaled steroids.

Using a short-acting beta-agonist as needed provides rapid symptom relief. Adding inhaled corticosteroids during viral infections helps reduce airway inflammation when symptoms are more likely to occur, lowering the need for frequent rescue therapy and avoiding the higher exposure and potential side effects of daily high-dose steroids. This approach matches common practice for mild or episodic asthma in this age group.

High-dose ICS/LABA isn’t appropriate for very young children as a routine initial regimen due to safety concerns and lack of indication in this age group. Oral corticosteroids are reserved for acute exacerbations rather than routine control. Immunotherapy isn’t used as a standard initial therapy for preschool asthma.

So the regimen of PRN SABA with ICS during respiratory infections is the best fit for initial therapy in children 0–4 years.