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
Other diagnostic factors
- age >3 years
- dry nighttime cough
- dyspnea on exertion
- expiratory wheezing
- chest wall deformity
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
Diagnostic investigations
1st investigations to order
- spirometry
- response to bronchodilator on spirometry
- chest x-ray
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
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
Queensland 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 has received multiple peer reviewed competitive grants from the Australian National Health and Medical Research Council. She is an author of a number of references cited in this topic.
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 topic.
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.
Use of this content is subject to our disclaimer