Asthma Management Handbook

Diagnosing asthma in children


A clinical definition of asthma in children

Asthma is defined clinically as the combination of variable respiratory symptoms (e.g. wheeze, shortness of breath, cough and chest tightness) and excessive variation in lung function, i.e. variation in expiratory airflow that is greater than that seen in healthy children (‘variable airflow limitation’).

See: A working definition of asthma

There is no single reliable test (‘gold standard’) and there are no standardised diagnostic criteria for asthma.

The clinical diagnosis of asthma in children involves the consideration of:

  • history of recurrent or persistent wheeze
  • presence of allergies or family history of asthma and allergies
  • absence of physical findings that suggest an alternative diagnosis
  • tests that support the diagnosis (e.g. spirometry in children able to perform the test)
  • a consistent clinical response to an inhaled bronchodilator or preventer.

Figure: Steps in the diagnosis of asthma in children Opens in a new window Please view and print this figure separately:

It can be difficult to diagnose asthma with certainty in children aged 0–5 years, because:

  • episodic respiratory symptoms such as wheezing and cough are very common in children, particularly in children under 3 years
  • objective lung function testing by spirometry is usually not feasible in this age group
  • a high proportion of children who respond to bronchodilator treatment do not go on to have asthma in later childhood (e.g. by primary school age).
  • A diagnosis of asthma should not be made if cough is the only or predominant respiratory symptom and there are no signs of airflow limitation (e.g. wheeze or breathlessness).

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