Diagnosis 

Features that make a diagnosis of asthma more likely in children include:

• A family or personal history of atopy

• FH of asthma

• >1 symptom such as episodic wheeze/cough/difficulty breathing/chest tightness

• Wheeze confirmed by a healthcare professional on auscultation

Other symptoms such as symptoms with colds only, isolated cough or moist cough make the diagnosis less likely.

Management 

A mother brings a 4-year-old child to see you with an ongoing dry cough for the past 3-4 months. The cough is worse in the evenings and wakes him up at night and also when he is playing outside. He does not get short of breath or wheezy. He is otherwise well in himself. You are considering a diagnosis of asthma and wish to start him on medication.

According to the National Institute for Health and Care Excellence (NICE) guidelines, what is the SINGLE MOST appropriate management option?

1. Salbutamol inhaler

2. Clarithromycin

3. Inhaled corticosteroid

4. Codeine linctus

5. Amoxicillin

The NICE guidelines recommend offering a short-acting beta2 agonist (SABA) as reliever therapy to children under 5 with suspected asthma. An 8‑week trial of a paediatric moderate dose of an inhaled corticosteroid (ICS) can also be considered if:

• symptoms at presentation that clearly indicate the need for maintenance therapy (for example, asthma-related symptoms 3 times a week or more, or causing waking at night) or

• suspected asthma that is uncontrolled with a SABA alone.

Cough suppressants including codeine should not be used in children under 12 years of age and antibiotics are not warranted here.

Resources:

Scott K. Chronic cough in children. InnovAiT 2021; 14(6): 356–363.

NICE. Asthma: diagnosis, monitoring and chronic asthma management. NG80. 2017 (updated 2021).

Exacerbations/acute asthma

• Moderate: 50-75% predicted or best

• Severe: 33-50% predicted or best

• Life-threatening: <33%

• Asthma (CKS)​

• Asthma (NHS Choices)

• British guideline on the management of asthma (British Thoracic society/SIGN, 2019)

• Resources (asthma.org.uk)