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Wheezing phenotypes and prediction of asthma in young children

Theresa W Guilbert, MD
Robert F Lemanske, Jr, MD
Section Editor
Gregory Redding, MD
Deputy Editor
Elizabeth TePas, MD, MS


Parents of infants and young children with recurrent wheezing often ask, "Does my child have asthma?" This is a question that clinicians involved in patient care and also those researching asthma would like to be able to answer. Preschool wheezing, a symptom that can herald the subsequent development of childhood asthma, is a common problem worldwide [1]. However, the condition improves and ultimately disappears by school years in many children. Proper identification of infants and young children at increased risk to develop persistent asthma may help predict long-term outcomes and improve prevention and treatment, but the ability to identify these children remains limited.

Several classifications of wheezing phenotypes and other tools have been developed in an effort to categorize children with recurrent wheezing and determine which will ultimately develop asthma. These wheezing phenotypes and predictive tools are reviewed in this topic. The definition and diagnosis of asthma in children; asthma risk factors, genetics, and natural history; bronchiolitis and virus-induced wheezing; and other causes of wheezing in children are discussed separately. (See "Asthma in children younger than 12 years: Initial evaluation and diagnosis" and "Asthma in children younger than 12 years: Epidemiology and pathophysiology" and "Natural history of asthma" and "Genetics of asthma" and "Risk factors for asthma" and "Approach to wheezing in infants and children" and "Wheezing illnesses other than asthma in children" and "Virus-induced wheezing and asthma: An overview" and "Treatment of recurrent virus-induced wheezing in young children" and "Bronchiolitis in infants and children: Clinical features and diagnosis".)


Almost 50 percent of children are reported to have wheezing in the first year of life, although only 20 percent will experience continued wheezing symptoms in later childhood [2]. Wheezing phenotypes have been defined to identify the characteristics and risk factors associated with children that experience wheezing [3]. Some of these phenotypes describe children who continue to wheeze until later childhood, while others identify those who continue to wheeze through adolescence and adulthood. However, the relationship between risk factors and the subsequent development of asthma in later childhood and adult life is not clear.

Many of these early childhood wheezing phenotypes were determined retrospectively in longitudinal studies. However, it can be difficult to clinically distinguish among these phenotypes during the preschool years, because of the variation in expression of both symptoms and risk factors over time. In addition, the application of these phenotypes to diverse populations is not established, and it is not clear which are the most effective therapies for a particular wheezing phenotype or whether early intervention can alter the course and outcome over time.

Epidemiologic phenotypes — Several epidemiologic phenotypes, based upon wheezing history, have been developed. There is some variability in age cutoffs differentiating among transient, persistent, and late-onset wheezing and inconsistencies in which risk factors are associated with each phenotype. There are also concerns about the prospective validity of these phenotypes.


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Literature review current through: Sep 2016. | This topic last updated: Nov 24, 2014.
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