Last reviewed: 4 Feb 2021
Last updated: 08 Feb 2021

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

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 reviewersVIEW ALL

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.

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