Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- desencadenantes de episodios de sibilancias
- mayor esfuerzo respiratorio
- características de la enfermedad atópica
- antecedentes de respuesta al tratamiento dentro del plazo adecuado
Other diagnostic factors
- edad >3 años
- tos nocturna seca
- disnea de esfuerzo
- sibilancia espiratoria
- deformidad de la pared torácica
Risk factors
- sensibilización alérgica
- enfermedad atópica
- infecciones de las vías respiratorias en las etapas tempranas de la vida
- eosinofilia sérica
- antecedentes familiares de asma o atopia
- Polimorfismos de genes y epigenética
- Fumar cigarrillos de forma pasiva o activa
- vapeo
- Tabaquismo materno en el embarazo
- función pulmonar anormal e hiperreactividad de las vías respiratorias
- Contaminación del aire interior y exterior
- estado socioeconómico bajo
- exposición a pesticidas
- sexo masculino
- obesidad
- enfermedad por reflujo gastroesofágico (ERGE)
- apnea obstructiva del sueño (AOS)
- tecnología de reproducción asistida
- cesárea
- Microbiota intestinal
- uso de fármacos supresores de ácido en el embarazo y la infancia
- uso de paracetamol en el embarazo
- Uso de antibióticos en el embarazo
Diagnostic investigations
1st investigations to order
- espirometría
- flujo espiratorio máximo (FEM)
- Respuesta al broncodilatador
Investigations to consider
- fracción exhalada de óxido nítrico (FeNO)
- pruebas de provocación de las vías respiratorias
- prueba de provocación con ejercicio
- hemograma completo (HC)
- prueba del sudor
- cultivo de esputo
- prueba de punción cutánea
- radiografía de tórax
- estudios ciliares de microscopía electrónica
- tomografía computarizada (TC) de tórax
- tomografía computarizada (TC) sinusal
- broncoscopia
Emerging tests
- lavado broncoalveolar
Treatment algorithm
edad 0 a 5 años
edad 6 a 11 años
Contributors
Authors
Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD, ATSF
Respiratory and Sleep Physician
Queensland Children's Hospital
Conjoint Professor
Child Health Research Centre
University of Queensland
Brisbane
Queensland
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 is an author of a number of references cited in this topic.
Peer reviewers
Kenan Haver, MD
Associate Professor of Pediatrics, Harvard Medical School
Boston Children's Hospital
Division of Pulmonary Medicine
Boston
MA
Disclosures
KH receives royalties from UpToDate.
Peter Griffiths, MBChB
General Practitioner
Harborne Medical Practice
Birmingham
UK
Disclosures
PG declares that he has no competing interests.
References
Key articles
Global Initiative for Asthma. 2024 Global strategy for asthma management and prevention. May 2024 [internet publication].Full text
National Institute for Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN). Nov 2024 [internet publication].Full text
National Institute for Health and Care Excellence. Asthma pathway (BTS, NICE, SIGN). Nov 2024 [internet publication].Full text
National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program. Guidelines for the diagnosis and management of asthma. Aug 2007 [internet publication].Full text
Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), Cloutier MM, Baptist AP, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-70.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Bronquiolitis
- Sibilancias episódicas (virales)
- Cuerpo extraño inhalado
More DifferentialsGuidelines
- Asthma pathway (BTS, NICE, SIGN)
- Global strategy for asthma management and prevention
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Neumonía
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Sibilancias espiratorias
Sibilancias polifónicas
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