Preschool Wheeze and the GINA 2025 Paradigm: Challenges and Adaptations for LMICs.

Wheezing in preschool children is a common clinical challenge characterized by a broad differential diagnosis and marked phenotypic heterogeneity. The Global Initiative for Asthma (GINA) 2025 guidelines introduce a structured framework for diagnosing asthma in this age group, shifting from a probabilistic to a more definitive labelling approach. While this represents a significant evolution, its applicability in low- and middle-income countries (LMICs) faces significant barriers including caregiver misreporting, limited diagnostic tools, and inconsistent follow-up. This article critically examines these challenges, particularly the risks of overdiagnosis and overtreatment in preschool wheeze within the LMIC context.