Inclusion Criteria

• For children in block 1
  • Must be enrolled in AMP at the time of study enrollment
• For Children in Block 2
  • Physician diagnosis of persistent asthma by NLP program from the list of physician diagnoses referring to persistent asthma
  • Has a persistent asthma equivalent condition defined by
    • The Healthcare Effectiveness Data and Information Set (e.g., ER visit or hospitalization for asthma during the past 12 months) 
    • The National Asthma Education and Prevention Program (e.g., ≥ 2 exacerbations requiring oral systemic corticosteroids in the past 6 months for children aged 0-4 years and 12 months for those aged ≥ 5 years)
  • Has a physician diagnosis of asthma with controller medication (e.g., inhaled corticosteroid) documented in the past 12 months, but was not enrolled in AMP at the time of enrollment or during run-in period
• For children in block 3
  • Must meet the criteria for asthma delineated in Table 1 in protocol for asthma and recurrent asthma-like symptoms, but do not have a documentation of a diagnosis of asthma in medical records aged 0-17 years

Exclusion Criteria

• For all blocks
  • Non-Olmsted County residents
  • Is not enrolled in Mayo Clinic downtown pediatric practice
  • Has no research authorization for using medical records for research
  • Is on immunosuppressive therapy
  • Has any condition making asthma ascertainment difficult for Block 3
    • Pulmonary function tests that showed forced expiratory volume at one second (FEV1) to be consistently below 50% predicted or diminished diffusion capacity
    • Tracheobronchial foreign body at or about the incidence date of asthma
    • Wheezing occurring only in response to anesthesia or medications
    • Bullous emphysema or pulmonary fibrosis on chest radiograph
    • Homozygous alpha 1-protease inhibitor deficiency alpha1-antitrypsin
    • Cystic fibrosis
    • Other major chest disease such as severe kyphoscoliosis or bronchiectasis
  • Declines to participate in the study