Precision medicine to diagnose asthma in preschool children: comparison of clinical scores, lung function, biomarkers, and genetic tests

Authors

Jose A. Castro-Rodriguez, Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. Electronic address: jacastro17@uc.cl.
Gustavo Nino, Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, George Washington University, Washington, DC, USA.
Asher Tal, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Erick Forno, Pediatric Pulmonology, Allergy/Immunology, and Sleep Medicine, Riley Hospital for Children, Indianapolis, IN, USA; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.

Document Type

Journal Article

Publication Date

9-20-2025

Journal

Paediatric respiratory reviews

DOI

10.1016/j.prrv.2025.09.001

Keywords

Asthma; Biomarkers; Clinical predictive indices; Epigenetic; Genetic; Lung function; Preschool; Recurrent wheezing

Abstract

Asthma is an umbrella term for several phenotypes and endotypes. It most frequently begins before the age of 6, with significant morbidity and decline in lung function occurring among all pediatric age groups. A delay in the diagnosis of asthma in preschoolers is associated with more severe exacerbations. One problem clinicians face is how to diagnose asthma early in its course; epidemiological phenotypes (i.e., transient, persistent, late-onset, and mid-childhood remitting wheeze) can only be ascertained retrospectively, and clinical phenotypes (e.g., episodic viral and multi-trigger wheeze) suffer from high variability and no relation with underlying pathological airway markers. International guidelines recommend that lung function tests and biomarkers be performed before diagnosing asthma in children under 5 years old. However, spirometry and airway resistance measures are typically normal in most preschoolers with asthma, and blood eosinophil counts, the most reliable biomarker for inhaled corticosteroid therapy, vary widely over time. Clinical predictive indices can help in predicting and diagnosing asthma in preschoolers. At least eight clinical predictive indices have been published, and four have been validated (API, PIAMA, APT, and PARS). Here, we will review the challenges of diagnosing asthma in the preschool age, the utility of several clinical indices, and the usefulness of incorporating biomarkers such as volatile organic components, exhaled breath condensate, and gene expression. Finally, we will discuss existing gaps and future directions for research in the field.

APA Citation

Castro-Rodriguez, Jose A.; Nino, Gustavo; Tal, Asher; and Forno, Erick, "Precision medicine to diagnose asthma in preschool children: comparison of clinical scores, lung function, biomarkers, and genetic tests" (2025). GW Authored Works. Paper 7921.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7921

Department

Pediatrics