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Diagnosis of asthma in children under five
1Imperial School of Medicine at the National Heart and Lung Institute, London, UK. a.bush@rbh.nthames.nhs.uk
Insights
Most childhood cough and wheeze are not serious. Diagnosis relies on history and examination, with few needing tests. Asthma diagnosis in children requires careful evaluation to prevent overdiagnosis and ineffective long-term treatment.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Diagnosis
Background:
- Cough and wheeze are prevalent symptoms in childhood, often not indicative of severe illness.
- Accurate diagnosis is crucial for appropriate management and to prevent overdiagnosis of conditions like asthma.
Purpose of the Study:
- To outline a diagnostic approach for children presenting with cough and wheeze.
- To evaluate the effectiveness of asthma diagnosis and treatment strategies in pre-school and older children.
Main Methods:
- Clinical evaluation based on history and physical examination to categorize children.
- Use of a three-step therapeutic trial protocol for asthma treatment in pre-schoolers.
- Emphasis on documenting variable airflow obstruction for asthma diagnosis in older children.
Main Results:
- Isolated cough without wheeze or breathlessness is unlikely to be asthma in community settings.
- Therapeutic trials for asthma in pre-schoolers showed disappointing results, with long-term prophylactic inhaled steroid therapy not reducing progression to mid-childhood asthma.
- Overdiagnosis of asthma in older children can be avoided by documenting variable airflow obstruction.
Conclusions:
- A systematic diagnostic approach based on clinical assessment is effective for managing childhood cough and wheeze.
- Current long-term prophylactic treatments and diagnostic approaches for childhood asthma, particularly in pre-schoolers, require re-evaluation due to limited efficacy and potential for overdiagnosis.
Abstract:
Cough and wheeze are common symptoms in childhood, but mostly do not signify a serious illness. On the basis of history and examination, such children should be allocated into one of five diagnostic categories. Very few need additional tests, although there are specific pointers in the initial evaluation which should actively be sought, and result in referral for investigation. In a community setting, isolated cough with no wheeze or breathlessness is most unlikely to be due to asthma. In pre-school children who cannot perform lung function tests, a therapeutic trial of asthma treatment may be indicated, but a three step protocol is mandatory, stopping therapy if there appears to be a response, and only restarting if symptoms recur. In older children, documentation of variable airflow obstruction before giving a diagnosis of asthma is important, to avoid overdiagnosis. Prophylactic therapy on a long term basis with inhaled steroids in pre-school children does not reduce the likelihood of progression to asthma in mid-childhood, and the results of treatment in terms of symptoms are disappointing.
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