Clinical Review

Diagnosis of asthma in children

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39234.651412.AE (Published 26 July 2007) Cite this as: BMJ 2007;335:198
  1. J Townshend, registrar in respiratory paediatrics,
  2. S Hails, paediatric respiratory nurse specialist,
  3. M Mckean, consultant in respiratory paediatrics
  1. Paediatric Respiratory Unit, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP
  1. Correspondence to: M Mckeanm.c.mckean{at}ncl.ac.uk
  • Accepted 29 May 2007

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

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 often uncertain whether children who wheeze do have asthma, and some people say that diagnosing asthma in very young children is not possible. An increasing body of evidence suggests that asthma is a complex disorder and that different patterns of illness have different underlying pathogenesis.

Many studies have investigated various treatments in older children with classic allergic asthma, yet relatively few have considered the many young children who have recurrent wheeze. Many common treatments now have a good evidence base, but gaps still exist, such as treatments for the most difficult and severe childhood asthma. Therapeutic advances include both new drugs and new licences for older drugs. For example, the new drug omalizumab and montelukast are now licensed down to 6 months of age. Yet despite …

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