Summary
Definition
History and exam
Key diagnostic factors
- wheezing
- shortness of breath
- tachypnea
- chest tightness
Other diagnostic factors
- cough
- exercise limitation
- tachycardia
- inability to speak or feed
- intercostal, subcostal, or sternal retraction
- accessory muscle use
- pulsus paradoxus
- sleep disturbance
- bradycardia
- cyanosis
- exhaustion
- decreased consciousness level
Risk factors
- viral infection
- uncontrolled asthma symptoms
- high use of short-acting beta-2 agonists (SABA)
- inadequate use of inhaled corticosteroids (ICS)
- incorrect inhaler technique
- low forced expiratory volume in 1 second (FEV₁)
- high bronchodilator reversibility
- inhaled allergens
- exercise
- poor adherence with regular asthma medication
- history of asthma
- history of other atopic disease
- family history of atopic disease
- history of hospitalization for asthma exacerbations
- one or more severe exacerbations in the past 12 months
- low socioeconomic status
- environmental irritants
- African-American ethnicity
- vitamin D deficiency
- obesity
- younger age
- low parental education
- bacterial infection
- emotion
- nonsteroidal anti-inflammatory drug (NSAID) use
Diagnostic investigations
1st investigations to order
- response to treatment with a short-acting beta-2 agonist (SABA)
- peak expiratory flow rate or FEV₁
- oxygen saturation
Investigations to consider
- arterial or venous blood gases
- chest x-ray
Treatment algorithm
life-threatening exacerbation or impending respiratory failure
severe exacerbation
mild to moderate exacerbation
Contributors
Authors
Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD
Respiratory and Sleep Physician
The Children's Hospital at Westmead
Clinical Professor
Discipline of Paediatrics and Child Health
Sydney Medical School
University of Sydney
Sydney
New South Wales
Australia
Disclosures
PDR declares that he has no competing interests.
Anne Chang, MBBS, FRACP, MPHTM, PhD
Professor
Menzies School of Health Research
Charles Darwin University
Northern Territory
Respiratory and Sleep Physician
Queensland Children's Hospital
Queensland University of Technology
Brisbane
Australia
Disclosures
AC's institution has received fees from her work on independent data monitoring committees for several unlicensed products including vaccines and a monoclonal antibody (GSK, AstraZeneca, and Moderna). She is an author of references cited in this topic.
Peer reviewers
Lucille A. Lester, MD
Professor of Pediatrics
University of Chicago Comer Children's Hospital
Chicago
IL
Disclosures
LAL declares that she has no competing interests.
Caro Minasian, BSc (Hons), MB, BS, FCPCH, MD (Res)
Consultant in Paediatrics
Adolescent Medicine & Paediatric Respiratory Medicine
University College London Hospitals NHS Foundation Trust
London
UK
Disclosures
CM declares that he has no competing interests.
Differentials
- Inhaled foreign body
- Viral-induced infantile wheezing
- Aspiration
More DifferentialsGuidelines
- Pocket guide for asthma management and prevention
- Australian asthma handbook
More GuidelinesPatient leaflets
Asthma in children: what is it?
Asthma in children: what treatments work?
More Patient leafletsVideos
Expiratory wheeze
Polyphonic wheeze
More videosLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer