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This document provides essential guidelines for diagnosing asthma in children, emphasizing recurrent respiratory symptoms such as wheezing, coughing, difficulty breathing, and chest tightness. It outlines clinical features that increase the likelihood of asthma, including personal and family histories of atopy, triggers like exercise and exposure to allergens, and responses to therapy. Conversely, the guidelines also identify symptoms that may indicate alternative diagnoses. Proper evaluation, including lung function tests, is crucial for accurate diagnosis and effective management in children aged 5-12 and those under 5 years.
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2008 Guidelines 2.1 DIAGNOSIS IN CHILDREN (1) Asthma in children causes recurrent respiratory symptoms of: • wheezing • cough • difficulty breathing • chest tightness
2008 Guidelines 2.1 DIAGNOSIS IN CHILDREN (2) Clinical features that increase the probability of asthma • More than one of the following symptoms: wheeze, cough, difficulty breathing, chest tightness, particularly if these symptoms: • are frequent and recurrent • are worse at night and in the early morning • occur in response to, or are worse after, exercise or other triggers, such as exposure to pets, cold or damp air, or with emotions or laughter • occur apart from colds • Personal history of atopic disorder • Family history of atopic disorder and/or asthma • Widespread wheeze heard on auscultation • History of improvement in symptoms or lung function in response to adequate therapy
2008 Guidelines 2.4 DIAGNOSIS IN CHILDREN (3) Clinical features that lower the probability of asthma • Symptoms with colds only, with no interval symptoms • Isolated cough in the absence of wheeze or difficulty breathing • History of moist cough • Prominent dizziness, light-headedness, peripheral tingling • Repeatedly normal physical examination of chest when symptomatic • Normal PEF or spirometry when symptomatic • No response to a trial of asthma therapy • Clinical features pointing to alternative diagnosis
Trial of Treatment Assess compliance and inhaler technique. Consider further investigation and/or referral Response? No Asthma diagnosis confirmed Continue Rx and find minimum effective dose CHILD with symptoms that may be due to asthma Clinical assessment Intermediate Probability Low Probability High Probability Consider tests of lung function and atopy Consider referral Investigate/treat other condition Response? Further investigation Consider referral Yes No Yes Continue Rx 5
