Asthma in children

Last reviewed: 9 Nov 2022
Last updated: 04 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • family history of asthma
  • history of passive or active tobacco smoking
  • wheezing episode triggers
  • increased work of breathing
  • features of atopic disease
  • history of response to treatment within appropriate time frame
More key diagnostic factors

Other diagnostic factors

  • age >3 years
  • dry nighttime cough
  • dyspnea on exertion
  • expiratory wheezing
  • chest wall deformity
Other diagnostic factors

Risk factors

  • allergic sensitization
  • atopic disease
  • wheezing triggered by nonviral/nonallergic environmental factors
  • respiratory viral infections in early life
  • serum eosinophilia (4% or greater)
  • family history of asthma
  • passive or active tobacco smoking
  • abnormal lung function and airway hyperresponsiveness
  • outdoor air pollution
  • female sex
  • obesity
  • acid-suppressive drug use in pregnancy
More risk factors

Diagnostic investigations

1st investigations to order

  • spirometry
  • response to bronchodilator on spirometry
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • peak expiratory flow rate (PEFR)
  • airway challenge tests
  • exercise challenge test
  • CBC
  • bronchoscopy
  • sweat test
  • sputum culture
  • electron micrograph ciliary studies
  • skin prick testing
  • fractional expired nitric oxide (FeNO)
  • bronchoalveolar lavage
More investigations to consider

Treatment algorithm

ONGOING

age 0 to 5 years

age 6 to 11 years

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, 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's institution has received fees from her work on the independent data monitoring committee board for an unlicensed vaccine (GSK) and as an advisory member of study design for an unlicensed molecule for chronic cough (Merck), outside the work for this topic. AC has received fees from UpToDate for writing chapters on cough in children. She is an author of a number of references cited in this topic.

Peer reviewers

Chris Cates, MA, FRCGP

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 topic.

Peter Griffiths, MBChB

General Practitioner

Harborne Medical Practice

Birmingham

UK

Disclosures

PG declares that he has no competing interests.

Karin A. Pacheco, MD, MSPH

Assistant Professor

Division of Environmental & Occupational Health Sciences

National Jewish Health

Denver

CO

Disclosures

KAP declares that she has no competing interests.

Ware Kuschner, MD

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.

  • Differentials

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