Child Health  |  Asthma Pathway - Diagnosis

Child Health

Asthma Pathway - Diagnosis

1. Asthma should be suspected in any child > 12 months with wheezing, ideally heard by a health professional on auscultation, and which is distinguished from upper airways noises.

2. Key features include:

  • Wheeze and breathlessness with or without cough
  • Variation in intensity and duration
  • Child experiences symptom-free periods

3. Recurrent cough in the absence of wheeze is unlikely to be due to asthma.

4. The presence of atopic disease in the child or immediate family increases the chance of asthma.

5. Base the diagnosis of asthma on:

  • The presence of key features and careful consideration of alternative diagnoses
  • Assessment of the response to trials of treatment, and ongoing assessment
  • Repeated reassessment of the child, and question the diagnosis if management is ineffective
  • Alternate diagnoses for wheezing child  or coughing child


Initial Clinical Assessment

B - Focus the initial assessment in children suspected of having asthma on:

  • Presence of key features in history and examination
  • Careful consideration of alternative diagnoses

Clinical Features that increase the probability of Asthma

  • More than one of the following symptoms - wheeze, cough, difficulty breathing, chest tightness - particularly if these 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; or 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

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 peak expiratory flow (PEF) or spirometry when symptomatic
  • No response to a trial asthma therapy
  • Clinical features pointing to alternative diagnosis

With a thorough history and examination, a child can usually be classed into one of three groups:

  • High probability - diagnosis of asthma likely
  • Low probability - diagnosis other than asthma likely
  • Intermediate probability - diagnosis uncertain

Record the basis on which a diagnosis of asthma is suspected

Last updated : Thursday, May 18, 2017
Next review date : Friday, May 18,2018

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