TABLE 1.

Operational diagnostic criteria for asthma in children one to five years of age

1. Documentation of airflow obstruction
Preferred	Documented wheezing and other signs of airflow obstruction by physician or trained health care practitioner
Alternative	Convincing parental report of wheezing or other symptoms of airflow obstruction
2. Documentation of reversibility of airflow obstruction
Preferred	Documented improvement in signs of airflow obstruction to SABA ± oral corticosteroids* by physician or trained health care practitioner
Alternative†	Convincing parental report of symptomatic response to a 3-month trial of a medium dose of ICS (with as-needed SABA)*
Alternative‡	Convincing parental report of symptomatic response to SABA
3. No clinical evidence of an alternative diagnosis

^*See Table 3 for further details regarding the recommended therapy or therapeutic trial;

^†In children with frequent symptoms and/or one or more exacerbation requiring rescue oral corticosteroids or a hospital admission;

^‡In children with mild intermittent symptoms and exacerbations, the diagnosis is only suggested because the accuracy of parental report of a short-term response to inhaled short-acting β₂-agonists (SABA) may be unreliable due to misperception and spontaneous improvement of another condition. Because this is a weaker alternative diagnostic method, confirmation by direct observation when symptomatic is preferred. ICS Inhaled corticosteroids