Last reviewed: November 2017
Last updated: December  2017

Summary

Definition

History and exam

Key diagnostic factors

  • FHx of asthma
  • hx of passive or active tobacco smoking
  • wheezing episode triggers
  • increased work of breathing
  • features of atopic disease
  • history of response to treatment within appropriate time frame

Other diagnostic factors

  • age >3 years
  • dry nighttime cough
  • dyspnea on exertion
  • expiratory wheezing
  • chest wall deformity

Risk factors

  • allergic sensitization
  • atopic disease
  • wheezing triggered by nonviral/nonallergic environmental factors
  • respiratory viral infections in early life
  • serum eosinophilia (4% or greater)
  • FHx of asthma
  • passive or active tobacco smoking
  • female gender
  • abnormal lung function and airway hyper-responsiveness
  • outdoor air pollution
  • obesity

Diagnostic investigations

1st investigations to order

  • spirometry
  • response to bronchodilator on spirometry
  • chest x-ray
Full details

Investigations to consider

  • peak expiratory flow rate (PEFR)
  • airway challenge tests
  • exercise challenge test
  • CBC
  • bronchoscopy
  • sweat test
  • sputum culture
  • electron micrograph ciliary studies
  • skin prick testing
  • fractional expired nitric oxide (FeNO)
  • bronchoalveolar lavage
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Staff Specialist

Department of Respiratory Medicine

Children's Hospital at Westmead

Senior Lecturer

Discipline of Paediatrics and Child Health

Sydney Medical School

University of Sydney

Sydney

New South Wales

Australia

Disclosures

PDR provided training and quality control overreading for multiple breath washout measurements performed during a pharmaceutical sponsored study. Reimbursement for the services provided were paid to PDR's place of work.

Professor

Respiratory and Sleep Physician

Lady Cilento Children's Hospital

Queensland Children’s Medical Institute

Queensland University of Technology

Brisbane

Menzies School of Health Research

Charles Darwin University

Darwin

Australia

Disclosures

AC is a member of the data safety monitoring committee in a vaccine study manufactured by GSK, and is a member of an advisory board for a compound manufactured by Merck for cough. AC is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL

Senior Clinical Research Fellow

Community Health Sciences

St. George's University of London

London

UK

Disclosures

CC is an author of a number of references cited in this monograph.

General Practitioner

Harborne Medical Practice

Birmingham

UK

Disclosures

PG declares that he has no competing interests.

Assistant Professor

Division of Environmental & Occupational Health Sciences

National Jewish Health

Denver

CO

Disclosures

KAP declares that she has no competing interests.

Associate Professor of Medicine

Stanford University

Stanford

Staff Physician

US Department of Veterans Affairs

Palo Alto Health Care System

Palo Alto

CA

Disclosures

WK declares that he has no competing interests.

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