2) Nonatopic Wheezing (NAW): This category accounts for about 20% of early wheezing children. There is no association of parental allergy or asthma in this group. There is an association with premature delivery. Many of these children have a lower respiratory infection in their first year. Most of the children no longer wheeze by school age (as in TEW). There is a strong association of NAW with living in a developing country or an inner city of America.
3) Atopic Wheezing (AW): This group is highly associated with family history of allergy and asthma. They account for about 20% of early wheezing children and predictably have a positive API. They have normal lung function early on but it is reduced by school age (compared to the other groups).
Recent research has focused on the impact of inflammation in the first few years of having asthma. The 2007 NIH guidelines for asthma emphasize the importance of early diagnosis and appropriate treatment, aimed at achieving good control by reducing impairment and minimizing risk. Young children with poorly controlled asthma have a higher risk of reduced lung growth and severe asthma attacks. The API may be used by doctors to determine which children should be followed more closely and perhaps have more long-term inhaled steroids.
Bottom Line: Having a negative API or being a TEW or NAW is a good indicator of short term breathing problems. As the child gets older, the need for asthma medications will become diminished. Children with a positive API or considered to be an AW will likely need long term controllers and periodic assessment of their asthma control.
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