Diagnosis of Asthma in Childern

COMPLEX DISORDER CHARACTERIZED BY VARIABLE AND RECURRING SYMPTOMS, AIRFLOW OBSTRUCTION, BRONCHIAL HYPERRESPONSIVNESS, AND UNDERLYING INFLAMMATION o o o Hx: o o o o o Use medical Hx and PE to determine that recurrent symptoms of airflow obstruction are present [Use spirometry in all pts 5 years old to determin airway obstruction that is at least partially reversible.] Consider alternative causes

Intermittent dry coughing Expiratory wheezing Daytime sx linked with physical activity or play Self-imposed limitation of physical activity Symptoms worse in presence of exrercise, respiratory infection, inhalant allergies, irritants, changes in weather o Symptoms often occur worse at night- can often awaken pt Risk factors o Allergic rhinitis o Allergic conjunctivitis o Atopic dermatitis o Food allergies o Parental asthma Did albuterol work to improve symptoms? No improvement with bronchodilator and steroid therapy inconsistent with asthma. PE: o Upper respiratory: Increased nasal secretions, mucosal swelling, nasal polyps o Chest: Wheezing during normal breathing or prolonged pahse of forced exhalation, hyperexpansion of thorax, uses of accessory muscles o Skin: atopy dermatitis, eczema Spirometry o Demonstrates obstruction. Airway blockage resulting in reduced airflow with forced exhalation and smaller partial expiratory lung volumes o FEV1/FVC <0.8 o Low FEV1 o Resolution (w/in 10 min) with SABA (Albuterol) Improve FEV1 > 12% and > 200ml Not peak flow which is used for monitoring DDx: o Upper airway Dz Allergic rhinitis, sinusitis o Obstruction involving large airways Foreign body Vocal Cord dysfunction o Vascular rings or laryngeal webs o Tracheal stenosis, bronchostenosis o Obstruction involving the small airways Viral bronchiolotis, oblirerative bronchiolits Cyctic fibrosis Bronshopulmonary dysplasia Heart Dz o Other Recurrent cough not due to asthma, aspiration from swallowing dysfunciton/ GERD

References: US dept. of Health and Human Services National Asthma Education and Prevention Program Expert Panel Report 3- 2007 Kliegman: Nelson Textbook of Pediatrics 19th ed- 2011 UW- SMPH dept. of Family Medicine- PCC Learning objectives and Resources