Initial Clinical Assessment:
- focus the initial assessment in children suspected of having asthma on:
- presence of key features in history and examination
- careful consideration of alternative diagnoses
Clinical features that increase the probability of asthma |
- more than one of the following symptoms
- wheeze, cough, difficulty breathing, chest tightness - particularly if these are frequent and recurrent; are worse at night and in the early morning; occur in response to, or are worse after, exercise or other triggers, such as exposure to pets; cold or damp air, or with emotions or laughter; or occur apart from colds
- personal history of atopic disorder
- family history of atopic disorder and/or asthma
- widespread wheeze heard on auscultation
- history of improvement in symptoms or lung function in response to adequate therapy
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Clinical features that lower the probability of asthma |
- symptoms with colds only, with no interval symptoms
- isolated cough in the absence of wheeze or difficulty breathing
- history of moist cough
- prominent dizziness, light-headedness, peripheral tingling
- repeatedly normal physical examination of chest when symptomatic
- normal peak expiratory flow (PEF) or spirometry when symptomatic
- no response to a trial of asthma therapy
- clinical features pointing to alternative diagnosis
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With a thorough history and examination, a child can usually be classed into one of three groups:
- high probability - diagnosis of asthma likely
- low probability - diagnosis other than asthma likely
- intermediate probability - diagnosis uncertain
Reference:
- (1) BTS/SIGN (May 2008). British Guideline on the Management of Asthma