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Case detection studies have used symptom questionnaires to screen for asthma in school-age
children. A small number of questions - about current symptoms, their relation to exercise and
their occurrence at night has been sufficient to detect asthma relatively efficiently. 11,12,14,44 The
addition of spirometry 11,44 or bronchial hyper-responsiveness testing 45 to these questionnaires
adds little to making a diagnosis of asthma in children.
B focus the initial assessment in children suspected of having asthma on:
presence of key features in the history and examination
careful consideration of alternative diagnoses.
; Record the basis on which a diagnosis of asthma is suspected.
2.1.2 ASSESSING THE PROBABLITy OF A DIAGNOSIS OF ASTHMA
Based on the initial clinical assessment it should be possible to determine the probability of a
diagnosis of asthma.
With a thorough history and examination, an individual child can usually be classed into one
of three groups (see Figure 1):
high probability – diagnosis of asthma likely
low probability – diagnosis other than asthma likely
intermediate probability – diagnosis uncertain.
2.1.3 HIGH PROBABILITy OF ASTHMA
In children with a high probability of asthma based on the initial assessment, move straight to
a diagnostic trial of treatment. The initial choice of treatment will be based on an assessment
of the degree of asthma severity (see section 4).
The clinical response to treatment should be reassessed within 2-3 months. In this group,
reserve more detailed investigations for those whose response to treatment is poor or those
with severe disease. 19
; In children with a high probability of asthma:
start a trial of treatment
review and assess response
reserve further testing for those with a poor response.
2.1.4 LOW PROBABILITy OF ASTHMA
Where symptoms, signs or initial investigations suggest that a diagnosis of asthma is unlikely, (see
Table 2), or they point to an alternative diagnosis (see Table 3), consider further investigations.
This may require referral for specialist assessment (see Table 4).
Reconsider a diagnosis of asthma in those who do not respond to specific treatments.
; In children with a low probability of asthma, consider more detailed investigation and
specialist referral.
2 diAGnosis
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