Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- fatores desencadeantes de episódios de sibilância
- aumento do esforço respiratório
- características de doença atópica
- história de resposta ao tratamento dentro do prazo adequado
Other diagnostic factors
- idade >3 anos
- tosse seca noturna
- dispneia ao esforço
- sibilância expiratória
- deformidade da parede torácica
Risk factors
- sensibilização alérgica
- doença atópica
- infecções do trato respiratório no início da vida
- eosinofilia sérica
- história familiar de asma ou atopia
- polimorfismos no gene e epigenética
- tabagismo passivo ou ativo
- vaping
- tabagismo materno durante a gestação
- função pulmonar anormal e hiper-responsividade das vias aéreas
- Poluição do ar em ambientes abertos e fechados
- condição socioeconômica baixa
- exposição a pesticidas
- sexo masculino
- obesidade
- doença do refluxo gastroesofágico (DRGE)
- apneia obstrutiva do sono (AOS)
- tecnologias de reprodução assistida
- parto cesáreo
- Microbiota intestinal
- uso de medicamento de supressão ácida na gestação e na infância
- uso de paracetamol na gestação
- uso de antibiótico na gestação
Diagnostic tests
1st tests to order
- espirometria
- Pico do fluxo expiratório (PFE)
- resposta ao broncodilatador
Tests to consider
- fração de óxido nítrico exalado (FeNO)
- testes de provocação das vias aéreas
- teste de desafio de exercício
- Hemograma completo
- teste do suor
- cultura de escarro
- teste alérgico cutâneo por puntura ("prick test")
- radiografia torácica
- estudos ciliares de eletromicrografia
- tomografia computadorizada (TC) do tórax
- tomografia computadorizada (TC) dos seios da face
- broncoscopia
Emerging tests
- lavagem broncoalveolar
Treatment algorithm
0 a 5 anos de idade
idade entre 6 e 11 anos
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
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
- Bronquiolite
- Sibilo (viral) episódico
- Corpo estranho inalado
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