As asthma in children differs from adult asthma, child-specific asthma guidelines should be used and adult and adolescent guidelines should not be extrapolated to younger age groups.
The prevalence of childhood asthma appears to have plateaued in many affluent countries. However, asthma remains a significant cause of childhood morbidity and mortality, and is still a common problem managed in ambulatory and emergency care settings.
Most children with asthma have mild intermittent asthma and do not require daily therapy. Minimum doses and medications for maximal control should be used in those who require preventive therapies. Therapy should be individualized.
A number of important differential diagnoses, adherence and environmental issues should be considered when evaluating a child with suspected asthma, especially in very young children or when high doses of inhaled corticosteroids are required.
Asthma is a chronic respiratory disorder characterized by variable airway inflammation, airway obstruction, and airway hyperresponsiveness. These features interact to determine the clinical symptom pattern of the individual. While the majority of asthmatic children have an intermittent symptom phenotype, the minority have persistent symptoms, reflecting the underlying chronic inflammation. In older children, as in adults, this may lead to permanent structural alterations of the airway wall (airway remodeling) and potentially a more severe asthma phenotype.
This topic covers the treatment of children up to 12 years of age. Children 12 years and older are treated the same as adults, except for emerging therapies such as bronchial thermoplasty. Please see our Asthma in adults topic for more information.
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
Other diagnostic factors
- age >3 years
- dry nighttime cough
- dyspnea on exertion
- expiratory wheezing
- chest wall deformity
- 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
- acid-suppressive drug use in pregnancy
1st investigations to order
- response to bronchodilator on spirometry
- chest x-ray
Investigations to consider
- peak expiratory flow rate (PEFR)
- airway challenge tests
- exercise challenge test
- sweat test
- sputum culture
- electron micrograph ciliary studies
- skin prick testing
- fractional expired nitric oxide (FeNO)
- bronchoalveolar lavage
age 0 to 5 years
age 6 to 11 years
- Episodic (viral) wheeze
- Inhaled foreign body
- Global strategy for asthma management and prevention (2021 update)
- Australian asthma handbook
Asthma in children: what is it?
Asthma in children: what treatments work?More Patient leaflets
Peak flow measurement: animated demonstrationMore videos
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer