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
- 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
Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD
Respiratory and Sleep Physician
The Children's Hospital at Westmead
Discipline of Paediatrics and Child Health
Sydney Medical School
University of Sydney
New South Wales
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.
Anne Chang, MBBS, FRACP, MPHTM, PhD, FAPSR, FThorSoc, FAHMS
Respiratory and Sleep Physician
Queensland Children's Hospital
Queensland University of Technology
Menzies School of Health Research
Charles Darwin University
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.
Chris Cates, MA, FRCGP
Senior Clinical Research Fellow
Community Health Sciences
St. George's University of London
CC is an author of a number of references cited in this topic.
Peter Griffiths, MBChB
Harborne Medical Practice
PG declares that he has no competing interests.
Karin A. Pacheco, MD, MSPH
Division of Environmental & Occupational Health Sciences
National Jewish Health
KAP declares that she has no competing interests.
Ware Kuschner, MD
Associate Professor of Medicine
US Department of Veterans Affairs
Palo Alto Health Care System
WK declares that he has no competing interests.
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