DIAGNOSIS OF ASTHMA IN CHILDREN 5 YEARS AND YOUNGER

DIAGNOSIS OF ASTHMA IN CHILDREN 5 YEARS AND YOUNGER

Diagnosis of asthma in children 5 years and younger presents a particularly difficult problem as wheezing and cough are also common in children. A useful method for confirming the diagnosis of asthma in this age group is a trial of treatment with short-acting bronchodilators and inhaled glucocorticoids. Marked clinical improvement during the treatment and deterioration when it is stopped supports a diagnosis of asthma. Three categories of wheezing have been described as:

• Transient early wheezing, often outgrown in the first 3 years and associated with prematurity and parental smoking.
• Persistent early-onset wheezing (before age 3). These children typically have recurrent wheezing associated with acute viral respiratory infections, no evidence of atopy, and no family history of atopy. Their symptoms persist through school age and adolescence.
• Late-onset wheezing/asthma. These children have persistent symptoms throughout childhood and into adult life. They typically have an atopy, often eczema, and     airway pathology that is characteristic of asthma.

Asthma predictive index:

 In a wheezing child < 3 years , the possibility of having bronchial asthma based on the presence of one major and two minor risk factors:-

Major risk factor	Minor risk factors
Parental history of asthma	Allergic rhinitis
Atopic dermatitis	Food sensitivity
	Wheezing unrelated to cold
	Eosinophilia

If present, then 65% likelihood of developing Asthma and if absent, then 95% likelihood of not developing Asthma.

Differential diagnosis of Wheeze:

• Chronic rhino-sinusitis
• Gastro-oesophageal reflux
• Recurrent viral lower respiratory tract infections
• Cystic fibrosis
• Bronchopulmonary dysplasia
• Tuberculosis
• Congenital malformation causing narrowing of the intrathoracic airways
• Foreign body aspiration
• Primary ciliary dyskinesia syndrome
• Immune deficiency
• Congenital heart disease