By: Clinton Dunn MD, FAAP & Addie Dodson, MD, FAAP
One in every 10 kids in the United States has
asthma, a breathing condition that can affect nearly every part of their lives. Asthma is one of the main reasons kids miss school. It's also a leading cause of childhood hospitalization.
Research shows that a family history of asthma is a risk that your child may develop it too. Early allergy symptoms are another possible red flag. Exposure to
tobacco or vape smoke,
air pollution, high temperatures (or a combination of these) can elevate asthma risks in kids. Here's what else to know about your child's risk for developing asthma.
Is it a cold—or an early sign of asthma?
Babies and toddlers are especially vulnerable to
colds and other respiratory infections such as rhino/enterovirus or
RSV. As they grow, their immune systems learn how to fight these viruses. But in a child's early years, doctors might notice
wheezing—a high-pitched, whistling sound when a child breathes.
Respiratory infections with wheezing in young children is one sign that your child might be at higher risk for asthma later. Your pediatrician or family doctor will look for other signs too. They may also use tools such as the Asthma Predictive Index (API) and the Pediatric Asthma Risk Score (PARS).
Tools that weigh your child's asthma risk factors
Asthma Predictive Index (API)
The API is based on a study of 1,000 children diagnosed with asthma before starting school (5 years old or earlier). The index suggests that children
3 years old or younger who have had
4 or more episodes of wheezing are likely to develop asthma if:
ONE of these factors is present:
At least one birth parent with asthma
Eczema, a condition that causes dry, itchy skin that make look reddish or purplish, depending on skin tone
OR if TWO or more of these factors are present:
Food allergies signaled by immediate symptoms after eating foods such as hives, swelling or vomiting
High levels of blood eosinophils, a type of white blood cell often seen in people with allergies or eczema
Wheezing that occurs when they are NOT sick with a colds or respiratory viruses
Pediatric Asthma Risk Score (PARS)
The
Pediatric Asthma Risk Score (PARS) tool was developed using data from the Cincinnati Childhood Allergy and Air Pollution Study. Each factor gets a point of 2 if present. PARS predicts the odds that a child will develop asthma at age 7 or later based on these 6 risk factors:
Parents with asthma: Has either of the child's biological parents ever been diagnosed or treated for asthma?
Eczema: Was the child diagnosed with eczema (atopic dermatitis) between birth and age 3 years?
Early wheezing: From birth to age 3 years, did the child ever
wheeze?
Wheezing when healthy: Did the child ever wheeze when not sick?
Ancestry: Is the child or either of his/her parents of black/African ancestry?
Allergies: Has the child ever had allergy skin testing (skin prick testing)?
Why an early diagnosis helps kids cope with asthma
Children with asthma need regular
medications to manage their breathing. Without these meds, they can experience
dangerous asthma flare-ups that may send them to the ER—and even threaten their life.
An early diagnosis can help your child's asthma care team prescribe the meds they will need, along with other lifestyle changes that help keep symptoms under control and decrease injury to their lungs. These meds will become part of an
asthma action plan that spells out exactly what to do when asthma symptoms flare up.
Your child's action plan gives clear guidance for all the adults who spend time with your child, from day care providers to teachers, coaches, camp counselors and others. With this plan in place, you can feel confident that these adults know how to respond to an asthma emergency.
Asthma & the "allergic march"
As the API and PARS show,
kids with allergies face higher risks for asthma than allergy-free kids. Conditions like eczema, eosinophilic esophagitis, food allergies and
nasal allergies or allergic rhinitis can develop slowly from birth, signaling a "march" toward an asthma diagnosis. This is why it's so crucial that your child's doctors work together to track symptoms and coordinate care.
More information
About Dr. Dunn
 Clinton Dunn, MD, FAAP, is a board-certified pediatrician and allergist/immunologist who practices in the Hampton Roads Virginia area. He is a member of the American Academy of Pediatrics (AAP) and the AAP Section on Allergy and Immunology. His clinical interests focus on atopic dermatitis, asthma, food allergy and applying high quality evidence-based medicine for the improvement of pediatric allergic/immunologic diseases.
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About Dr. Dodson
 Addie Dodson, MD, FAAP, is a board-certified pediatrician and currently completing her fellowship in pediatric pulmonology at Children's Hospital Los Angeles. Dr. Dodson is a member of the AAP Section on Pediatric Pulmonology and Sleep Medicine. She currently serves as the section's executive committee fellow-in-training liaison. Dr. Dodson's clinical interests within pulmonology are growing while she continues in her fellowship, but she has special interests in asthma, use of technology to improve practice, medical education and advocacy.
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