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Asthma in children

Last reviewed: 18 Jun 2025
Last updated: 20 May 2025

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
Full details

Other diagnostic factors

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

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
Full details

Diagnostic tests

1st tests to order

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

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
Full details

Emerging tests

  • bronchoalveolar lavage

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 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

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

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

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Diagnósticos diferenciais

    • Bronchiolitis
    • Episodic (viral) wheeze
    • Inhaled foreign body
    Mais Diagnósticos diferenciais
  • Diretrizes

    • Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN)
    • Asthma pathway (BTS, NICE, SIGN)
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Asthma in children: what is it?

    Asthma in children: what treatments work?

    Mais Folhetos informativos para os pacientes
  • Videos

    Expiratory wheeze

    Polyphonic wheeze

    Mais vídeos
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