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