Asthma frequently begins in childhood. The first manifestation is often recurrent wheezing during the preschool years, predominantly associated with viral respiratory infection and perturbation of the airway microbiome. Sometimes early onset wheeze is transient, but it can evolve into persistent asthma with multifactorial wheeze triggered by infections, allergens, irritants or exercise. This progression of persistent wheeze evolving into allergic or nonallergic asthma can last a lifetime and is treatable but not curable. Emerging evidence indicates that risk factors and pathophysiological mechanisms differ among asthma phenotypes. Defining links between mechanisms and phenotypes to diagnose asthma endotypes precisely could provide the foundational knowledge to improve treatment and develop preventive strategies.

哮喘通常始于儿童期。第一个表现通常是学龄前儿童反复出现喘息，主要与病毒性呼吸道感染和气道微生物群扰动有关。有时，早发性喘息是短暂的，但它可以演变成持续性哮喘，由感染、过敏原、刺激物或运动引发的多因素喘息。持续性喘息演变成过敏性或非过敏性哮喘可能会持续一生，并且可以治疗但无法治愈。新的证据表明，不同哮喘表型的危险因素和病理生理机制有所不同。定义机制和表型之间的联系以精确诊断哮喘内型可以为改善治疗和制定预防策略提供基础知识。