Summary
Definition
History and exam
Key diagnostic factors
- wheezing episode triggers
- increased work of breathing
- features of atopic disease
- history of response to treatment within appropriate time frame
- family history of asthma
- history of passive or active tobacco smoking
Other diagnostic factors
- age >3 years
- dry nighttime cough
- dyspnea on exertion
- expiratory wheezing
- chest wall deformity
Risk factors
- allergic sensitization
- 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 hyperresponsiveness
- indoor and outdoor air pollution
- low socioeconomic status
- pesticide exposure
- male sex
- obesity
- gastroesophageal reflux disease (GERD)
- obstructive sleep apnea (OSA)
- assisted reproductive technologies
- cesarean section
- intestinal microbiota
- acid-suppressive drug use in pregnancy and childhood
- acetaminophen use in pregnancy
- antibiotic use in pregnancy
Diagnostic tests
1st tests to order
- spirometry
- peak expiratory flow (PEF)
- response to bronchodilator
Tests to consider
- fractional expired nitric oxide (FeNO)
- airway challenge tests
- exercise challenge test
- CBC
- sweat test
- sputum culture
- skin prick testing
- chest x-ray
- electron micrograph ciliary studies
- chest CT
- sinus CT
- bronchoscopy
Emerging tests
- bronchoalveolar lavage
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 of a number of references cited in this topic.
Revisores
Kenan Haver, MD
Associate Professor of Pediatrics, Harvard Medical School
Boston Children's Hospital
Division of Pulmonary Medicine
Boston
MA
Declarações
KH receives royalties from UpToDate.
Peter Griffiths, MBChB
General Practitioner
Harborne Medical Practice
Birmingham
UK
Declarações
PG declares that he has no competing interests.
Referências
Principais artigos
Global Initiative for Asthma. 2024 Global strategy for asthma management and prevention. May 2024 [internet publication].Texto completo
National Institute for Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN). Nov 2024 [internet publication].Texto completo
National Institute for Health and Care Excellence. Asthma pathway (BTS, NICE, SIGN). Nov 2024 [internet publication].Texto completo
National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program. Guidelines for the diagnosis and management of asthma. Aug 2007 [internet publication].Texto completo
Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), Cloutier MM, Baptist AP, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-70.Texto completo Resumo
Artigos de referência
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Diagnósticos diferenciais
- Bronchiolitis
- Episodic (viral) wheeze
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- Asthma pathway (BTS, NICE, SIGN)
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