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
- wheezing triggered by non-viral/non-allergic environmental factors
- respiratory viral infections in early life
- serum eosinophilia (4% or greater)
- FHx of asthma
- passive or active tobacco smoking
- female sex
- abnormal lung function and airway hyper-responsiveness
- outdoor air pollution
- obesity
Diagnostic investigations
1st investigations to order
- spirometry
- response to bronchodilator on spirometry
- CXR
Investigations to consider
- peak expiratory flow rate (PEFR)
- airway challenge tests
- exercise challenge test
- FBC
- bronchoscopy
- sweat test
- sputum culture
- electron micrograph ciliary studies
- skin prick testing
- fractional expired nitric oxide (FeNO)
- bronchoalveolar lavage
Treatment algorithm
Contributors
Authors
Respiratory and Sleep Physician
The Children's Hospital at Westmead
Associate Professor
Discipline of Paediatrics and Child Health
Sydney Medical School
University of Sydney
Sydney
New South Wales
Australia
Disclosures
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.
Professor
Respiratory and Sleep Physician
Lady Cilento Children's Hospital
Queensland University of Technology
Brisbane
Menzies School of Health Research
Charles Darwin University
Darwin
Australia
Disclosures
AC is a member of the data safety monitoring committee in a vaccine study manufactured by GSK, and is a member of an advisory board for a compound manufactured by Merck for cough. AC is an author of a number of references cited in this monograph.
Peer reviewers
Senior Clinical Research Fellow
Community Health Sciences
St. George's University of London
London
UK
Disclosures
CC is an author of a number of references cited in this monograph.
General Practitioner
Harborne Medical Practice
Birmingham
UK
Disclosures
PG declares that he has no competing interests.
Assistant Professor
Division of Environmental & Occupational Health Sciences
National Jewish Health
Denver
CO
Disclosures
KAP declares that she has no competing interests.
Associate Professor of Medicine
Stanford University
Stanford
Staff Physician
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto
CA
Disclosures
WK declares that he has no competing interests.
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