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remains important for optimal
medication deposition. Digital applications and plans, counsel-
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Table 1. Differential diagnoses
Disease
Signs and symptoms
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Box 2. Red flags for morbidity and mortality in asthma |
standard spirometry( see figure 1) performed in an accredited respiratory laboratory is the gold standard |
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ling on adverse effects of social practices, like the negative effect of smoking and vaping, can assist in improving asthma control. Consider tertiary referral for vaping cessation if this is having a significant impact on the adolescent’ s asthma control.
Aboriginal and Torres Strait Islander children
About 12 % of Aboriginal and Torres
Strait Islander children aged 0-14 have a diagnosis of asthma, which is higher than that of the general population. 13 They are at a significantly increased risk of both severe and / or uncontrolled asthma and mortality compared with
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Airway abnormalities( eg, tracheoesophageal fistula)
Allergic rhinitis and / or sinusitis
Stridor, wheeze, tachypnoea
Frequent sneezing, nasal congestion and / or rhinorrhoea( particularly mornings), itchy / red eyes
Anaphylaxis Urticarial rash, tachypnoea, stridor, wheeze, diarrhoea and / or vomiting
Aspiration
Bronchiolitis
Chronic suppurative disease( eg, non-cystic fibrosis bronchiectasis)
Prematurity, neurodevelopmental delay, hypotonia
Age less than two, wheeze, coarse crackles, poor feeding, hypoxia
Purulent nasal discharge, recurrent acute otitis media, haemoptysis, digital clubbing, persistent coarse crepitations, wheeze, prolonged wet cough
Cardiac Cyanosis, tachypnoea, wheeze, heart murmur, thoracotomy scar, hepatomegaly
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• Poor adherence to preventer therapy.
• Short-acting beta 2 agonist overuse.
• Poor understanding of asthma medications.
• Multiple hospital presentations.
• Adolescent male.
• Vulnerable social background.
• Aboriginal and / or Torres Strait Islander.
• Poor healthcare engagement.
• ICU admission.
Source: Global Initiative for Asthma 2023 1
performed in preschool children, asthma can still be present. There-
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for diagnosis of asthma in children. 1 A bronchodilator response may continue to be present in children with uncontrolled asthma. It may be an indicator of poor treatment adherence or suboptimal treatment, so can also be a useful objective measure for monitoring.
In addition to spirometry, fractional exhaled nitric oxide( FeNO) is being utilised more often. FeNO is a surrogate marker for eosinophilic airway inflammation, with levels greater than 35ppb indicative of significant airway inflammation. 23, 24 FeNO cannot be used to diagnose asthma as its levels can be altered in other chronic respiratory
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non-Indigenous children. The issues of particular concern in these communities include healthcare engagement, treatment adherence, lower socio- |
Diffuse / interstitial lung disease
Tachypnoea, wheeze, hypoxia, fine crepitations
Foreign body aspiration Recent history of choking, unilateral chest signs, stridor, wheeze, persistent cough
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fore, consider a trial of inhaled therapy as part of the diagnostic workup in all children with symptoms of asthma. For episodic wheeze, a trial |
diseases( for example, high FeNO in
23, 24 uncontrolled allergic rhinitis). However, it is still a useful marker of asthma control when used in
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demographic factors, and children exposed to antenatal maternal smoking and current household smoking. 14
It is important that healthcare pro-
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Mass( intra- or extraluminal) Lymphadenopathy, weight loss, night sweats, stridor, wheeze
* The listed symptoms and diseases are not exhaustive but include the most common
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of salbutamol, as required, is warranted. For children with more frequent asthma symptoms, consider a 4-8-week trial of a regular preventer |
combination with other key asthma indicators like interval symptoms, SABA use, FEV1 and / or the presence of a significant bronchodilator |
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fessionals provide culturally safe and sensitive care for this population. |
Source: National Asthma Council Australia 7 |
and a reliever as required. Most importantly, reassess any |
response on serial lung function testing. FeNO can be done in |
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Many GPs who work within these communities appreciate the value of engaging local elders and community |
vulnerable. 17, 18 Currently, about 30 % of the Australian popula- |
( AAPs) and education booklets. Consider using these resources to |
child started on regular inhaled therapy within 4-8 weeks to determine their response. An improve- |
accredited respiratory laboratories when spirometry is undertaken. |
supports to assist in a child’ s asthma |
tion were born overseas and more |
improve equitable care provision in |
ment in symptoms would be |
SKIN PRICK TESTING |
care. GPs are encouraged to link families with their local Aboriginal Medical Services, use“ Closing the Gap” on prescriptions, and use culturally appropriate resources like the Short Wind flipchart or the Lung Health for Kids app by the Menzies School of |
than 300 languages are spoken. 19 Healthcare engagement, access to care and health literacy levels can be significant barriers to effective asthma care in children from these communities. 17, 20 Care may also be affected by language barriers, cul- |
these marginalised communities.
DIAGNOSTIC APPROACH
THE diagnostic approach to asthma
in children is highly dependent on the age of the presenting child.
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expected and is suggestive of a diagnosis of asthma. 7
Six or older
GPs can utilise several specialist
investigations in children over six for the diagnosis of asthma and
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Skin prick testing is the quickest and most efficient method of assessing allergic sensitisation and can support the diagnosis of asthma. 25 It can also help identify potential common contributing environmental triggers affecting asthma control, like house |
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15, 16
Health Research to engage families.
Culturally and linguistically diverse communities, refugee and out-of-home care status
Culturally and linguistically diverse
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tural differences and differences in patient – doctor perceptions. 21, 22 Several organisations, including the National Asthma Council Australia, Sydney Children’ s Hospitals Network and The Royal Children’ s Hospital Melbourne have translated |
Under six
A diagnosis of asthma is more symptom-driven
in children under six, relying on appropriate clinical history taking, examination and a heightened awareness of asthma
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ongoing disease surveillance.
SPIROMETRY Spirometry is most reliable in children aged older than five for both diagnosis and monitoring treatment response in asthma. A bron-
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dust mites, pollens, grasses and other aeroallergens. 26
Skin prick testing use in asthma has been well established for decades. 27, 28 The testing itself is minimally invasive, requires no preparation and is well toler-
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communities, refugee families and |
asthma resources including multi- |
and disease-specific pointers. Even |
chodilator response of at least a 12 % |
ated, even by younger children, |
children in out-of-home care are |
media videos, asthma action plans |
though diagnostic tests cannot be |
rise and a 0.2L increase in FEV1 on |
when performed by trained health |