Inclusion Criteria:

- ages 4 to 18 years

- diagnosis of asthma or symptoms of persistent wheeze, unexplained by an etiology
other than asthma

Exclusion Criteria:

- other severe co-morbidity (cystic fibrosis, sickle cell disease, chronic lung disease
of prematurity, interstitial lung disease, cerebral palsy)

- inability of family to provide informed consent

- plans of the family to move out of the greater Cleveland area in the subsequent 24
months

- or inability to participate in regular follow up visits