Asthma: basis and management at different ages

Abstract

The first half of the meeting was devoted to the early life origins of asthma and opened with an address from Michael Silverman (Paediatric Respiratory Medicine at the Royal Postgraduate Medical School, London, U.K.). There are problems with the proper definition of early asthma in childhood, and the concepts of asthma which have been derived from clinical and epidemiological work on school children and young adults cannot be applied to pre-school children. If one sticks to a definition of asthma as a. chronic inflammatory condition in which heightened bronchial responsiveness is associated with recurrent, reversible airway obstruction, then the syndrome of asthma cannot be shown to exist in this age group. There is no evidence concerning the nature or persistence of an inflammatory process in the airways of wheezy young children. There is also no evidence to support a greater degree of bronchial responsiveness in wheezy infants (or in any wheezy children up to the age of 7 years) compared with their non-wheezy counterparts. Finally, there are few, if any, data on the variability of airway obstruction with time in children with wheezing conditions under 5 years of age.