Early childhood bronchial asthma: current concepts

Early childhood bronchial asthma is defined on a clinical basis as the occu rrence of at least three episodes of wheeze before 2 years of age, once exc luded a chronic obstructive lung disease, mainly cystic fibrosis. Recent bi rth cohort studies (Tucson, Wight island) showed that approximately 40% of early childhood asthma remain symptomatic in later childhood. Thus in any y oung child with asthma the question is raised of ifs significance, ie trans ient bronchial hyper-reactivity or first manifestations of a chronic asthma . At the present time, there is no specific marker which may clearly differ entiate between these two opposite evolutions, and the evidence for an atop ic predisposition remains the best predictive criteria for persistent asthm a. This justifies preventive measures directed towards environmental protec tion of the at risk young child : mainly passive smoking and allergen avoid ance. (C) 1999 Elsevier, Paris.