Section 4, Managing Asthma Long Term in Children 0–4 Years of Age and 5–11 Years of Age

Several studies show that as many as 50–80 percent of children who have asthma develop symptoms before their fifth birthdays. Diagnosis can be difficult in this age group and has important implications. On the one hand, asthma in early childhood is frequently underdiagnosed (receiving such inappropriate labels as chronic bronchitis, wheezy bronchitis, reactive airway disease (RAD), recurrent pneumonia, gastroesophageal reflux, and recurrent upper respiratory tract infections). Therefore, many infants and young children do not receive adequate therapy. On the other hand, not all wheeze and cough are caused by asthma, and caution is needed to avoid giving infants and young children inappropriate prolonged asthma therapy. Episodic or chronic wheeze, cough, and breathlessness also may be seen in other, less common, conditions, including cystic fibrosis, vascular ring, tracheomalacia, primary immunodeficiency, congenital heart disease, parasitic disease, and foreign-body aspiration.