Last reviewed: 9 Apr 2021
Last updated: 29 Mar 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • wheezing
  • shortness of breath
  • tachypnoea
  • chest tightness

Other diagnostic factors

  • cough
  • exercise limitation
  • tachycardia
  • inability to speak or feed
  • intercostal, sub-costal, or sternal retraction
  • accessory muscle use
  • pulsus paradoxus
  • sleep disturbance
  • bradycardia
  • cyanosis
  • exhaustion
  • decreased consciousness level

Risk factors

  • viral infection
  • uncontrolled asthma symptoms
  • high use of short-acting beta-2 agonists
  • inadequate use of inhaled corticosteroids
  • incorrect inhaler technique
  • low forced expiratory volume in 1 second (FEV₁)
  • high bronchodilator reversibility
  • inhaled allergens
  • exercise
  • poor adherence with regular asthma medication
  • history of asthma
  • history of other atopic disease
  • family history of atopic disease
  • history of hospitalisation for asthma exacerbations
  • one or more severe exacerbations in the past 12 months
  • low socio-economic status
  • environmental irritants
  • African-American ethnicity
  • vitamin D deficiency
  • obesity
  • younger age
  • low parental education
  • bacterial infection
  • emotion
  • non-steroidal anti-inflammatory drug (NSAID) use

Diagnostic investigations

1st investigations to order

  • response to treatment with a short-acting beta-2 agonist
  • peak expiratory flow rate or FEV₁
  • oxygen saturation

Investigations to consider

  • arterial or venous blood gases
  • chest x-ray

Treatment algorithm


Respiratory and Sleep Physician

The Children's Hospital at Westmead

Clinical Associate Professor

Discipline of Paediatrics and Child Health

Sydney Medical School

University of Sydney


New South Wales



PDR has received research funds from governmental bodies such as the Australian National Health and Medical Research Council. 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.


Menzies School of Health Research

Charles Darwin University

Northern Territory

Respiratory and Sleep Physician

Queensland Children's Hospital

Queensland University of Technology




AC has received research funds from governmental bodies such as the Australian National Health and Medical Research Council. Her institution has received fees from her work on the independent data monitoring committee board for an unlicensed vaccine (GSK) and as an advisory member of study design for an unlicensed molecule for chronic cough (Merck), outside the work for this topic. AC also received fees from UpToDate for writing topics on cough in children. AC is an author of references cited in this topic.

Peer reviewersVIEW ALL

Professor of Pediatrics

University of Chicago Comer Children's Hospital




LAL declares that she has no competing interests.

Consultant in Paediatrics

Adolescent Medicine & Paediatric Respiratory Medicine

University College London Hospitals NHS Foundation Trust




CM declares that he has no competing interests.

Use of this content is subject to our disclaimer