For the management of asthma in children aged 0-4, what is the first-step option?

In managing asthma in children aged 0-4, the first step is to use a short-acting beta-agonist (SABA) as needed. This approach is based on the need for quick relief of asthma symptoms, such as wheezing, coughing, or difficulty breathing. SABAs work by relaxing the muscles around the airways, allowing for easier airflow and immediate symptom relief.

For very young children, particularly under the age of 4, the initial focus is on symptom control rather than long-term management with anti-inflammatory medications, such as inhaled corticosteroids (ICS). Hence, a SABA provides effective rescue therapy to address acute exacerbations.

Other options like low or medium-dose ICS are typically considered after establishing a diagnosis and ensuring the child has persistent asthma, which would necessitate regular anti-inflammatory therapy. High-dose ICS would be used in cases of severe asthma, typically after confirming that lower treatments are inadequate. This hierarchical approach ensures that children swiftly transition to more effective therapies as their asthma characteristics become clearer.