Asthma in Preschool Children: A Review of the Diagnostic Challenges

Abstract

Family physicians face many challenges when diagnosing asthma in preschool children. These diagnostic challenges are compounded by variations in the natural history of early stage asthma, which are not fully understood, since early childhood wheezing and asthma are heterogeneous disorders with many phenotypic and variable expressions. Since no standard definition for the type, severity, or frequency of symptoms exist for this age group, clear evidence-based recommendations are lacking. Without adequate guidance, family physicians are left to make diagnostic and treatment decisions, which can lead to undertreatment of asthmatics and overtreatment of transient wheezers. New guidelines that specifically address the challenges of diagnosing asthma in this particular age group (Global Initiative for Asthma, British Thoracic Society/Scottish Intercollegiate Guidelines Network) have recently been published, and researchers are actively seeking new methods and techniques through epidemiological studies to assist primary care clinicians in the diagnostic process. This review has wide application in primary care. By recognizing the diagnostic challenges and understanding the related best practices, family physicians will be better placed to treat, manage, and control asthma symptoms, resulting in lower morbidity rates and reduced health system costs, as well as enhancing the overall quality of life and well-being of the children affected. (J Am Board Fam Med 2014;27:538 -548.)

Airway Microbial Diversity is Inversely Associated with Mite-Sensitized Rhinitis and Asthma in Early Childhood

“…The physician-diagnosed phenotypes of atopic diseases were evaluated by the same pediatric pulmonologist at the outpatient clinics. Asthma was diagnosed as ever having asthma, with the occurrence of recurrent wheeze in the last 12 months, or current use of asthma medication, based on the guidelines of the Global Initiative for Asthma 28 . Allergic rhinitis was diagnosed as having symptoms such as sneezing, nasal congestion, itching, and rhinorrhea in the last 12 months 29 .…”

Association of Mycoplasma pneumoniae infection with increased risk of asthma in children

“…Currently, there are no specific treatments for asthma and long-term standard treatment may reduce the recurrence of asthma, but evidence has also suggested that early intervention is essential for the patients with asthma (5–8). However, the diagnosis of asthma in children is difficult and easily misdiagnosed, which may result in under treatment of asthmatics or overtreatment of transient wheezes and lead to lung function impairment (9). Therefore, a correct and timely diagnosis of asthma in children is the first step towards effective management and treatment of asthma, which may reduce the potential harm due to misdiagnosis (10).…”

Association of macrophage migration inhibitory factor promoter polymorphism –173G/C with susceptibility to childhood asthma

“…Asthma is the most common chronic inflammatory disease of childhood, characterized by periodic obstruction of the airways and respiratory symptoms such as wheezing, cough and breathlessness [1]. It affects one child in 7 in some societies and approximately 300 million individuals worldwide.…”