Early childhood bronchial asthma: current concepts

Early childhood bronchial asthma is defined on a clinical basis as the occurrence of at least three episodes of wheeze before 2 years of age, once excluded a chronic obstructive lung disease, mainly cystic fibrosis. Recent birth cohort studies (Tucson, Wight island) showed that approximately 40% of early childhood asthma remain symptomatic in later childhood. Thus in any young child with asthma the question is raised of ifs significance, ie transient bronchial hyper-reactivity or first manifestations of a chronic asthma. At the present time, there is no specific marker which may clearly differentiate between these two opposite evolutions, and the evidence for an atopic predisposition remains the best predictive criteria for persistent asthma. This justifies preventive measures directed towards environmental protection of the at risk young child : mainly passive smoking and allergen avoidance. (C) 1999 Elsevier, Paris.