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Asthma in children

Last reviewed: 11 Feb 2025
Last updated: 18 Sep 2024

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
Full details

Other diagnostic factors

  • age >3 years
  • dry night-time cough
  • dyspnoea on exertion
  • expiratory wheezing
  • chest wall deformity
Full details

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
Full details

Diagnostic investigations

1st investigations to order

  • spirometry
  • peak expiratory flow (PEF)
  • response to bronchodilator
Full details

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
Full details

Emerging tests

  • fractional expired nitric oxide (FeNO)

Treatment algorithm

ONGOING

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
    More Differentials
  • Guidelines

    • Global strategy for asthma management and prevention
    • GEMA 5.3. Spanish guideline on the management of asthma
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  • Patient information

    Asthma in children: what is it?

    Asthma in children: what treatments work?

    More Patient information
  • Videos

    Expiratory wheeze

    Polyphonic wheeze

    More videos
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