Clinical Review

Diagnosis and management of asthma in children

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h996 (Published 05 March 2015) Cite this as: BMJ 2015;350:h996
  1. Andrew Bush, professor of paediatrics and head of section (paediatrics)1, professor of paediatric respirology2, consultant paediatric chest physician3,
  2. Louise Fleming, senior clinical lecturer2, consultant respiratory paediatrician3
  1. 1Section of Paediatrics, Imperial College, London W2 1PG, UK
  2. 2National Heart and Lung Institute, Imperial College, London, UK
  3. 3Department of Paediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust London, UK
  1. Correspondence: A Bush a.bush{at}imperial.ac.uk

The bottom line

  • In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment

  • If diagnostic doubt still exists, including a failure to respond adequately to a low to medium dose of inhaled corticosteroids, referral should be made to a specialist team

  • Asthma is a disease that kills, even in children with “mild” asthma, and care must be seen in that context

  • Any emergency visit to hospital, regardless of whether admission occurs, is a marker of future risk, and should prompt a focused and urgent review of what trigger factors led to the attack and whether the attack was appropriately managed

  • Non-adherence to treatment, overuse of bronchodilators, and underuse of inhaled corticosteroids are common problems that should be routinely tackled

  • Failure of annual asthma review is a factor in asthma related deaths and for children a review should be routine at least every three months; these should be conducted by doctors or nurses with training in asthma and not seen as “tick box” exercises

  • When specialist services are also involved, good communication is essential; this is particularly true after an acute asthma attack

Asthma is a condition characterised clinically by recurrent episodes of wheeze, cough, and breathlessness, and physiologically by variable airflow obstruction. Airway inflammation is sometimes added to the definition, but it is rarely measured in clinical practice; some groups would consider episodic viral wheeze in preschool children as a separate condition. This review gives a practical perspective on the basic steps of diagnosis and management of asthma in school age children for non-specialists in primary and secondary care.

Sources and selection criteria

We performed a search of PubMed using the terms “asthma” or “wheeze”, with the filters “clinical trial”, “published in the last 5 …

View Full Text

Sign in

Log in through your institution

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial

Subscribe