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Pearce et al. 1995). Despite the stabilization in the last few years and the reduction in previous
high mortality, asthma remains a prevalent paediatric disease (Kercsmar 2006; Weinberger
and Abu-Hasan 2006).
t.4
L4.I The asthma diagnosis in national and international guidelines
Prior to the difficulties regarding treatment, particularly in children, the first hurdle is making
a correct diagnosis of asthma which cornmences by having an appropriate definition. The
2005 'British Guideline on the Management of Asthma' from the British Thoracic Society &
Scottish Intercollegiate Guidelines Network (SIGN) guideline states; ,.The diagnosis of
asthma is a clinical one; there is no confirmatory diagnostic blood test, radiographic or
histopathological investigation. In some people a diagnosis can be corroborated by suggestive
changes in lung function tests" (SIGN 2005). The problem of accurate diagnosis appears to
have existed for many decades. "The clinical diagnosis of asthma is not always simple and the
absence of an agreed definition of the disease is a problem with many descriptions existing,,
appeared in 1959 from a conference on 'terminology' (Anonymous 1959). The difficulties of
diagnosis and differential diagnoses are apparent in the paediatric section of the SIGN
guideline and in two paediatric asthma guidelines published in 2005; 'pocket Guide for
Asthma Management and Prevention in Children' from the 'Global Initiative for Asthma,
(GINA) (GINA 2005), and the 'Management of Asthma in Children aged I -
15 years' from
the Paediatric Society of New 7*aland (NZPAG) (Paediatric Society of New Tnaland2005).
Ultimately these publications agree that it is a clinical diagnosis based on a history of
appropriate symptoms of wheeze, which varies over time, improving either spontaneously or
as a result of treatment and with wheezeheard, during times of exacerbation. However all
indicate this should occur in the absence of other features that could suggest congenital,
suppurative or atypical respiratory disease, or is not responsive to asthma treatment.
L4.2 Wat is meant by 'wheeze'?
Even here there are at least two difficulties. Firstly, what is meant by 'wheeze' and secondly,
that not all wheeze is asthma. Parental reporting of wheezing does not always coincide with
what doctors mean by wheezing (Cane, Ranganathan et al. 2000;Cane and McKenzie Z0(lI).
Of parents presenting with infants with a problem of 'noisy breathing', 59Vo used the term
'wheeze' to describe their concern. However, after being shown video clips illustrating
wheezing and other airway noises, only 36Vo continued to describe their infant as wheezing.