Key pointsChildhood asthma and wheezing illness encompass a wide clinical spectrum.Most children with asthma first present before the age of 3 years.Coexistent atopy and initial disease severity carry a poor long-term prognosis.A switch from male to female predominance occurs at puberty.Good prognostic factors include presentation before 2 years of age and exclusively virally induced episodes.CME article: educational aimsTo identify the different types of wheezing illness in asthma that present in childhood.To aid healthcare professionals in the discussion of medium- to long-term prognosis with parents of children presenting with wheezing illness.To place prophylactic therapy in the context of the natural history of the disease.SummaryChildhood asthma covers a wide spectrum, ranging from mild-intermittent to severe-persistent disease, with different natural histories. Female sex, age at presentation, atopic constitution, parental atopy, and severity and frequency of attacks can all be identified as risk factors for persistence into adult life, while others, including maternal smoking, prematurity and bronchiolitis of infancy, do not appear to be associated to such an extent. The use of prognostic features alongside assessment of disease severity should inform long-term clinical management and be useful in counselling the child and her/his family.

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