Asthma is the most common chronic illness of childhood. Of the 15 million people with asthma in the United States, 5 million are children or adolescents. This number represents between 3% and 7% of children in the United States. Asthma prevalence in children younger than 5 years has increased 160% from 1980 through the end of the 1990s.[1] In 80% of patients with asthma, the onset of symptoms occurred before the age of 5 years.[2] Childhood asthma is responsible for 13 million physician visits, 200,000 hospitalizations, 10 million lost school days, and over 550,000 emergency room visits per year. Over 8 million prescriptions for asthma medications are written for children. This condition is responsible for 3 times the number of missed school days when compared with children without asthma. Approximately 78% of parents have reported negative effects on their family. An estimated 36% of parents of asthmatic children have missed work in the last year, resulting in over $1 billion in lost parental productivity.[2] Most asthma care is delivered by primary care physicians. Approximately 78% of children (and 58% of adults) receive their care from primary care physicians such as pediatricians and family practitioners. Only 20% of children in the United States see a specialist for this condition (compared with 36% of adults).

Many risk factors are associated with childhood asthma. The most common cause of wheezing in infants and young children is viral upper respiratory tract infections, but the strongest predictor for wheezing continuing into asthma is atopy.[1] A significant association exists between serum immunoglobulin E (IgE) level and the development or severity of asthma. Certain allergens and irritant exposures increase the risk for asthma. In the inner city, cockroach allergy has been associated with the significant development of signs and symptoms of this condition. Irritant exposures, particularly a history of maternal smoke exposure is a risk factor as well. Prematurity is also a risk factor. Several candidate genetic loci have been proposed based on epidemiologic linkage studies. These loci include an association of chromosome 5q with bronchial hyper-responsiveness, chromosome 11q13 with high-affinity IgE receptors, and chromosome 14q with T-cell antigen receptor.[3] [4]

Many pediatricians and primary care physicians do not realize that childhood asthma is a fatal disorder.[2] The number of deaths has more than doubled in the last 2 decades. Of great concern is that most patients who die are not seen as high risk; many are viewed to have mild disease. Certain risk factors have been associated with death from asthma, including:

1. History of sudden severe exacerbations
2. Prior admissions to an intensive care unit
3. Prior intubation for asthma
4. Two or more hospitalizations or 3 or more emergency department visits in a 12-month period
5. Use of more than 1 canister per month of inhaled short-acting β-agonist
6. Chronic use of oral corticosteroids
7. Difficulty perceiving airflow obstruction or its severity