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Asthma in Children (cont.)

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How is asthma in children diagnosed?

The diagnosis of asthma in children is often a purely clinical diagnosis. A typical history is a child with a family history of asthma and allergies who experiences coughing and difficulty breathing when playing with friends and/or who experiences frequent bouts of bronchitis or prolonged respiratory infections. Improvement with a trial of asthma medications essentially confirms the diagnosis of asthma.

If the child is old enough, they may undergo testing to aid in the diagnosis of asthma. Spirometry is a breathing test to measure lung function and children can generally start performing proper technique for this testing around 5 years of age. Another test is exhaled nitric oxide (FeNO), which is a marker for airway inflammation, and this test may also be performed starting around 5 years of age. In younger children who cannot perform proper technique for lung function testing, impulse oscillometry is used to measure airway resistance. It should be noted, however, that this is a fairly involved test and it is rarely ordered in the diagnosis of pediatric asthma. The vast majority of younger children are diagnosed based on history alone.

Other objective measures to help in the diagnosis of pediatric asthma include using a peak flow meter, which can help to estimate lung function. Sometimes, testing for airway hyperresponsiveness (methacholine or mannitol challenge) can help diagnosis asthma, again in older children capable of performing proper technique. Chest X-rays can sometimes be helpful to aid in the diagnosis of asthma. They may show hyperinflation, but are often completely normal. Allergy testing can also be helpful in diagnosis, since the risk of asthma is higher in children with sensitizations to common environmental aeroallergens. It is very important to recognize that a child can have poorly-controlled asthma despite completely normal lung function. Therefore, normal lung function does not preclude the diagnosis of asthma if a physician's clinical suspicion is high.

Medically Reviewed by a Doctor on 11/17/2015


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