PHENOTYPES OF BRONCHIAL ASTHMA IN CHILDREN: CLINICAL FEATURES, DIAGNOSTIC CHALLENGES AND PERSONALIZED MANAGEMENT

Background: Childhood bronchial asthma is a heterogeneous chronic airway disease in which similar symptoms may arise from different developmental, environmental and inflammatory pathways. Recognition of clinically meaningful phenotypes may improve diagnostic precision and support individualized management. Objective: To synthesize current evidence on major pediatric asthma phenotypes, their clinical characteristics, diagnostic challenges and implications for personalized care. Materials and Methods: A narrative literature review was performed using recent international asthma guidance and peer-reviewed literature indexed in PubMed, with emphasis on pediatric phenotype/endotype studies, preschool wheeze, obesity-associated asthma, severe therapy-resistant asthma and biomarker-guided biologic therapy. Results: Pediatric asthma can be described through overlapping clinical dimensions including age at onset, symptom pattern, trigger profile, atopic status, obesity, exacerbation tendency, treatment response and inflammatory biomarkers. Allergic/eosinophilic asthma is commonly associated with early onset, atopy and Type 2 inflammation, whereas viral-associated preschool wheeze may be episodic and diagnostically difficult to distinguish from other causes of recurrent wheeze. Obesity-associated asthma may present with disproportionate symptoms and altered lung-function patterns, while severe asthma may contain eosinophilic, allergic, neutrophilic or paucigranulocytic subgroups. Diagnostic uncertainty is greatest in children aged five years and younger, in whom objective lung-function testing is often limited. In older children, spirometry with bronchodilator assessment, repeated clinical assessment and selected biomarkers can strengthen diagnostic confidence and phenotype characterization. Personalized management should first confirm the diagnosis and address modifiable factors, inhaler technique, adherence and comorbidities; phenotype and biomarkers can then inform additional treatment, including biologics in appropriately selected severe asthma. Conclusion: Phenotyping is most useful as a dynamic clinical framework rather than a rigid classification. Combining clinical history, objective lung function, atopy, biomarkers, comorbidities and longitudinal treatment response offers a practical pathway toward individualized pediatric asthma care.