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Not all wheezing in childhood is due to asthma. When symptoms persist or start after the age of three, especially in combination with other allergic symptoms such as eczema, the diagnosis of asthma is much more likely.

There are several medical conditions that can cause wheezing, cough, and other symptoms of asthma in children that must be excluded:

• Upper respiratory tract infections (rhinitis, sinusitis, tonsil or adenoid enlargement)
• Lower respiratory tract infections (pneumonitis, bronchiolitis)
• Airway obstruction (i.e., laryngeal webs, foreign body aspiration, vocal cord dysfunction)
• Cystic fibrosis
• Bronchopulmonary dysplasia
• Gastroesophageal reflux disease (GERD)
• Congenital heart disease
• Pneumonia
• Tuberculosis
• Pertussis
• Swallowing dysfunction

Many children have their first episode of asthma in the first 3 years of life. During this period, it is difficult to distinguish a first episode of asthma from bronchiolitis, a viral infection of the bronchi and bronchioles, caused primarily by respiratory syncytial virus which is common in the fall and winter and affects most young infants.