BMJ  2007;335:198-202 (28 July), doi:10.1136/bmj.39234.651412.AE

Clinical Review

Diagnosis of asthma in children

Paediatric Respiratory Unit, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP

Children presenting with wheeze are likely to have either atopic asthma or episodic viral wheeze; distinguishing between these has important implications for management

The first 150 words of the full text of this article appear below.

Summary points "Childhood asthma" describes several different clinical phenotypes with different management strategies The two most common phenotypes are atopic asthma, more common in school aged children, and episodic viral wheeze, more common in preschool children Wheeze is a poorly understood symptom, and parents should be asked to clarify what they understand it to be Wheeze is commonly associated with asthma, but several other conditions can result in recurrent wheezing and should be considered before a diagnosis is made

If it's wheeze it must be asthma, and if it's asthma it must mean bronchodilators and inhaled corticosteroids—simple enough. Indeed, as asthma is so common this paradigm might seem to be logical. The large scale international study of asthma and allergy in childhood (ISAAC) found that the United Kingdom, Australia, and New Zealand had among the highest prevalences, with 15% of children affected.¹ Asthma is more complicated, however, especially in children. We are . . . [Full text of this article]

Searches and selection criteria

How do patients present?

Atopic asthma
Box 1: Causes of chronic cough in childhood
Chronic suppurative lung disease
Environmental pulmonary toxic agents
Airways lesion
Upper airway disease
Oesophageal/swallowing problems
Interstitial lung disease
Others
Episodic viral wheezing
Other causes of wheeze

What are the key features in the history and examination?

Box 2: A guide to history taking and examination
Pattern of illness
Severity of illness
Examination
During episodes
Between episodes

What investigations might help?

Conclusion

Additional educational resources
Information resources for patients

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