Can Asthma Be Predicted? Early Signs, Risk Factors & Diagnosis in Children

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) also can elevate asthma risks in kids.

Learn more about key risk factors, signs to watch for, tools that can gauge a child’s asthma risk and how early diagnosis makes a difference.

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. In a child’s early years, doctors might notice
wheezing—a high-pitched whistling sound when a child breathes.

Respiratory infections with wheezing is one sign that your child might be at higher risk for asthma later. Their pediatrician will look for other signs too. They may 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 medicines, 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 medicines they will need, along with other lifestyle changes that help keep symptoms under control and decrease injury to their lungs. These medications 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.

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