title: "To wheeze or not to wheeze": That is not the question.
abstract: BACKGROUND
  The diagnosis of asthma in young children is difficult and based on clinical assessment of symptoms and results of physical examination. Respiratory wheeze has traditionally been used to define asthma in young children.
  
  
  OBJECTIVE
  We sought to compare the qualitative diagnosis of wheeze with a quantitative global assessment of significant troublesome lung symptoms during the first 3 years of life as a predictor of asthma by age 7 years.
  
  
  METHODS
  Children born to asthmatic mothers (n= 411) were followed prospectively to age 7 years. Parents were instructed to visit the research clinic during the first 3 years of life each time the child had significant troublesome lung symptoms for 3 days. At the clinic, a research physician performed a physical examination, including auscultation for wheeze and excluding differential diagnoses. We tested whether wheeze was independently associated with asthma at age 7 years after adjusting for the total number of episodes.
  
  
  RESULTS
  Three hundred thirteen children had full follow-up by age 7 years. In a multivariable analysis the total number of acute clinic visits for asthma symptom was significantly associated with later asthma (P< .0001), whereas the presence of wheeze at these visits was not (P= .5). The total number of acute clinic visits for significant troublesome lung symptoms was also significantly associated with later asthma in children who had never presented with any wheeze (P= .03).
  
  
  CONCLUSIONS
  A quantitative global assessment of significant troublesome lung symptoms in the first 3 years of life is a better predictor of asthma than assessment of wheeze. Doctor-diagnosed wheeze is not a prerequisite for the diagnosis of asthma, and relying on the symptom of wheeze will likely be an important cause of undertreatment.
authors: Copenhagen Prospective Studies on Asthma in Childhood, Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Nanna
authors: N
authors: Skytt
authors: Klaus
authors: K
authors: Bønnelykke
authors: Hans
authors: H
authors: Bisgaard
mesh_terms: D017668:Age of Onset; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008168:Lung / Q000276:immunology / Q000503:physiopathology*; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012135:Respiratory Sounds / Q000175:diagnosis* / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires