Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- 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 night-time cough
- dyspnoea on exertion
- expiratory wheezing
- chest wall deformity
Risk factors
- allergic sensitisation
- atopic disease
- respiratory tract infections in early life
- serum eosinophilia
- family history of asthma or atopy
- gene polymorphisms and epigenetics
- passive or active cigarette smoking
- vaping
- maternal smoking in pregnancy
- abnormal lung function and airway hyper-responsiveness
- indoor and outdoor air pollution
- low socio-economic status
- pesticide exposure
- male sex
- obesity
- gastro-oesophageal reflux disease (GORD)
- obstructive sleep apnoea (OSA)
- assisted reproductive technologies
- cesarean section
- intestinal microbiota
- acid-suppressive drug use in pregnancy and childhood
- paracetamol use in pregnancy
- antibiotic use in pregnancy
Diagnostic investigations
1st investigations to order
- spirometry
- peak expiratory flow (PEF)
- response to bronchodilator
Investigations to consider
- airway challenge tests
- exercise challenge test
- FBC
- sweat test
- sputum culture
- skin prick testing
- chest x-ray
- electron micrograph ciliary studies
- chest CT
- sinus CT
- bronchoscopy
- bronchoalveolar lavage
Emerging tests
- fractional expired nitric oxide (FeNO)
Treatment algorithm
age 0 to 5 years
age 6 to 11 years
Contributors
Authors
Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD, ATSF
Respiratory and Sleep Physician
Queensland Children's Hospital
Conjoint Professor
Child Health Research Centre
University of Queensland
Brisbane
Queensland
Australia
Disclosures
PDR declares that he has no competing interests.
Anne Chang, MBBS, FRACP, MPHTM, PhD, FAPSR, FThorSoc, FAHMS
Professor
Respiratory and Sleep Physician
Queensland Children's Hospital
Queensland University of Technology
Brisbane
Menzies School of Health Research
Charles Darwin University
Darwin
Australia
Disclosures
AC is an author for UptoDate and receives chapter royalties. She is an author of a number of references cited in this topic.
Peer reviewers
Kenan Haver, MD
Associate Professor of Pediatrics, Harvard Medical School
Boston Children's Hospital
Division of Pulmonary Medicine
Boston
MA
Disclosures
KH receives royalties from UpToDate.
Peter Griffiths, MBChB
General Practitioner
Harborne Medical Practice
Birmingham
UK
Disclosures
PG declares that he has no competing interests.
Differentials
- Bronchiolitis
- Episodic (viral) wheeze
- Inhaled foreign body
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- GEMA 5.3. Spanish guideline on the management of asthma
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