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Preschool Wheeze and the GINA 2025 Paradigm: Challenges and Adaptations for LMICs
Nikhil Rajvanshi1, Prawin Kumar2, Paul Aurora1
1Department of Pediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, United Kingdom.
Indian Pediatrics
|March 16, 2026
Summary
New asthma guidelines for preschool children may be hard to use in low-income countries. Challenges like caregiver misreporting and limited tools risk overdiagnosis and overtreatment of childhood wheeze.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Global Health
Background:
- Wheezing in preschool children presents diagnostic challenges due to varied causes and presentations.
- The Global Initiative for Asthma (GINA) 2025 guidelines propose a definitive asthma diagnosis framework for this age group.
- Current diagnostic approaches often rely on probabilistic assessments.
Purpose of the Study:
- To critically examine the applicability of the GINA 2025 asthma diagnostic framework in low- and middle-income countries (LMICs).
- To identify barriers to implementing the new GINA guidelines for preschool wheeze in LMICs.
- To assess the risks of overdiagnosis and overtreatment in LMICs.
Main Methods:
- Critical review of the GINA 2025 guidelines.
- Analysis of challenges specific to LMIC contexts, including caregiver reporting and diagnostic infrastructure.
- Examination of potential consequences of guideline implementation in resource-limited settings.
Main Results:
- Significant barriers exist for applying the GINA 2025 framework in LMICs.
- Caregiver misreporting, inadequate diagnostic tools, and inconsistent follow-up are key challenges.
- These factors increase the risk of misdiagnosis, leading to potential overdiagnosis and overtreatment.
Conclusions:
- The GINA 2025 asthma guidelines, while evolving, face substantial implementation hurdles in LMICs.
- Careful consideration and adaptation are needed to prevent overdiagnosis and overtreatment of preschool wheeze in these settings.
- Further research is required to develop contextually appropriate diagnostic strategies for childhood asthma in LMICs.
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