Review Article Towards a better understanding of childhood asthma

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Abstract
To explore the ways asthma may be defined in childhood and consider the current evidence to support these possible definitions. The relationship of symptoms, atopy, bronchial hyperresponsiveness (BHR) and airway inflammation in defining childhood asthma is reviewed. While none of the four proposed methods of defining asthma can stand alone as the 'gold standard', in childhood asthma, all four, namely clinical symptoms, atopy, BHR and airway inflammation, are intimately related. The degree of atopy and BHR, and the presence of airway inflammation, should be viewed as significant risk factors for persistent wheezing in childhood. At present the clinical diagnosis of asthma in childhood remains largely based on symptoms but it is likely that, with further research, the group of children who are now labelled as having asthma will be subdivided into different subgroups with implications for both treatment and outcome.