Subscribe for unlimited access to DynaMed content, CME/CE & MOC credit, and email alerts on content you follow.

Already subscribed? Sign in now

Learn more about CME

Chronic Asthma in Children

MoreVert
AddCircleOutlineFollow
ShareShare
AddCircleOutlineFollow
Follow
ShareShare
Share

General Information

Description

  • chronic inflammatory disorder of airways defined by history of respiratory symptoms (wheeze, shortness of breath, chest tightness, and cough) and variable expiratory airflow limitation1,2,3

Definitions

  • elements of good asthma control include1,2,3
    • no daytime symptoms or night-time awakening due to asthma
    • no need for rescue medication
    • no asthma exacerbations
    • no limitations on activity including exercise
    • normal lung function (forced expiratory volume in 1 second (FEV1) or peak expiratory flow (PEF) > 80% predicted or best)
    • minimal side effects from medication

Types

  • asthma phenotypes commonly seen in childhood do not correlate strongly with specific pathologic processes or treatment response1,3
    • allergic asthma
      • often begins in childhood
      • associated with past and/or family history of allergic disease such as eczema, allergic rhinitis, or food or drug allergy
      • sputum may reveal eosinophilic airway inflammation
      • elevated IgE level
    • asthma with obesity

References

General references used

  1. Global Initiative for Asthma (GINA) global strategy for asthma management and prevention. GINA 2018OpenInNew
  2. British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN) national clinical guideline on management of asthma. BTS/SIGN 2016 Sept PDFPictureAsPdf
  3. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol. 2007 Nov;120(5 Suppl):S94-138OpenInNew or at National Heart, Lung, and Blood Institute (NHLBI)OpenInNewPDFPictureAsPdf, correction can be found in J Allergy Clin Immunol 2008 Jun;121(6):1330

Recommendation grading systems used

  • Global Initiative for Asthma (GINA) grading system for evidence
    • levels of evidence
      • Evidence A - randomized controlled trials (RCTs) and meta-analyses, rich body of data
      • Evidence B - RCTs and meta-analyses, limited body of data
      • Evidence C - nonrandomized trials and observational studies
      • Evidence D - expert panel consensus judgment
    • Reference - GINA global strategy on asthma management and prevention (GINA 2018OpenInNew)
  • British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) definitions of grades of recommendation and levels of evidence
    • grades of recommendations
      • Grade A
        • at least 1 meta-analysis, systematic review, or randomized controlled trial (RCT) rated as 1++ and directly applicable to the target population, or
        • body of evidence consisting principally of studies rated as 1+, directly applicable to target population and demonstrating overall consistency of results
      • Grade B
        • body of evidence including studies rated as 2++, directly applicable to target population and demonstrating overall consistency of results, or
        • extrapolated evidence from studies rated as 1++ or 1+
      • Grade C
        • body of evidence including studies rated as 2+, directly applicable to target population and demonstrating overall consistency of results, or
        • extrapolated evidence from studies rated as 2++
      • Grade D
        • evidence level 3 or 4, or
        • extrapolated evidence from studies rated as 2+
      • Good Practice Point - recommended best practice based on clinical experience of guideline development group
    • levels of evidence
      • 1++ - high-quality meta-analyses, systematic reviews of RCTs, or RCTs with very low risk of bias
      • 1+ - well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with low risk of bias
      • 1- - meta-analyses, systematic reviews of RCTs, or RCTs with high risk of bias
      • 2++
        • high-quality systematic reviews of case-control or cohort studies
        • high-quality case-control or cohort studies with very low risk of confounding or bias and high probability that relationship is causal
      • 2+ - well-conducted case-control or cohort studies with low risk of confounding or bias and moderate probability that relationship is causal
      • 2- - case-control or cohort studies with high risk of confounding or bias and significant risk that relationship is not causal
      • 3 - nonanalytical studies (for example, case reports, case series)
      • 4 - expert opinion
    • Reference - BTS/SIGN national clinical guideline on management of asthma (BTS/SIGN 2016 Sep PDFPictureAsPdf)
  • National Heart, Lung, and Blood Institute (NHLBI) grading system for evidence
    • Evidence A - randomized controlled trials, rich body of data
    • Evidence B - randomized controlled trials, limited body of data
    • Evidence C - nonrandomized trials and observational studies
    • Evidence D - expert panel consensus judgment
    • Reference - NHLBI National Asthma Education and Prevention Program guideline on diagnosis and management of asthma (NHLBI 2007OpenInNewPDFPictureAsPdf or in 17983880J Allergy Clin Immunol 2007 Nov;120(5 Suppl):S94OpenInNew), correction can be found in J Allergy Clin Immunol 2008 Jun;121(6):1330

DynaMed Editorial Process

Special acknowledgements

  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Recommendations Editors provide explicit review of DynaMed Overview and Recommendations sections to ensure that all recommendations are sound, supported, and evidence-based. This process is described in "Synthesized Recommendation Grading."
    Deputy Editors are employees of DynaMed and oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T919350, Chronic Asthma in Children; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T919350. Registration and login required.
  • KeyboardArrowRight

    Overview and Recommendations

    • Background

    • Evaluation

    • Management

  • Related Summaries

  • KeyboardArrowRight

    General Information

    • Description

    • Definitions

    • Types

  • KeyboardArrowRight

    Epidemiology

    • Incidence/Prevalence

    • Risk factors

    • Associated conditions

  • Etiology and Pathogenesis

  • KeyboardArrowRight

    History and Physical

    • Clinical presentation

    • KeyboardArrowRight

      History

      • History of present illness (HPI)

      • Medication history

      • Past medical history (PMH)

      • Family history (FH)

      • Social history (SH)

    • KeyboardArrowRight

      Physical

      • General physical

      • Skin

      • HEENT

      • Chest

      • Lungs

  • KeyboardArrowRight

    Diagnosis

    • KeyboardArrowRight

      Making the diagnosis

      • Overview of diagnosis

      • Making the diagnosis in children < 5 years old

      • Making the diagnosis in children aged 5-11 years

    • Differential diagnosis

    • Testing overview

    • KeyboardArrowRight

      Pulmonary function tests

      • Spirometry

      • Peak expiratory flow (PEF)

      • Fractional exhaled nitric oxide (FeNO) testing

      • Bronchial provocation tests

    • Testing not routinely performed

  • KeyboardArrowRight

    Management

    • Management overview

    • Diet

    • Activity

    • Counseling

    • KeyboardArrowRight

      Medications

      • Principles of stepwise treatment

      • Overview of pharmacologic treatment for children < 5 years old

      • Overview of pharmacologic treatment for children aged 5-11 years

      • Other medications

    • Consultation and referral

    • KeyboardArrowRight

      Other management

      • Use of inhaler devices

      • Asthma education and asthma action plan

      • Treatment of gastroesophageal reflux in asthma

      • Alternative therapies for asthma

      • Environmental interventions

      • Perioperative and severe illness considerations

      • Telemedicine

      • Breathing retraining

    • Follow-up

  • KeyboardArrowRight

    Complications and Prognosis

    • Prognosis

  • KeyboardArrowRight

    Prevention and Screening

    • Prevention

    • Screening

    • Immunization

  • KeyboardArrowRight

    Quality Improvement

    • Choosing Wisely

    • Choosing Wisely Canada

    • Choosing Wisely Italy

  • KeyboardArrowRight

    Guidelines and Resources

    • KeyboardArrowRight

      Guidelines

      • International guidelines

      • United States guidelines

      • United Kingdom guidelines

      • Canadian guidelines

      • European guidelines

      • Asian guidelines

      • Central and South American guidelines

      • Australian and New Zealand guidelines

    • Review articles

    • MEDLINE search

  • Patient Information

  • KeyboardArrowRight

    ICD Codes

    • ICD-10 codes

  • KeyboardArrowRight

    References

    • General references used

    • Recommendation grading systems used

    • DynaMed Editorial Process

    • Special acknowledgements

    • How to cite

Topic Editor
Floyd R. Livingston MD
KeyboardArrowDown
Affiliations

Clinical Professor of Pediatrics, University of Central Florida School of Medicine; Florida, United States; Clinical Associate Professor of Pediatrics, The Florida State University College of Medicine; Florida, United States; Division Chief, Pediatric Pulmonary & Sleep Medicine, Nemours Children’s Hospital; Florida, United States

Conflicts of Interest

Dr. Livingston declares no relevant financial conflicts of interest.

Recommendations Editor
Zbys Fedorowicz MSc, DPH, BDS, LDSRCS
KeyboardArrowDown
Affiliations

Director of Bahrain Branch of the United Kingdom Cochrane Center, The Cochrane Collaboration; Awali, Bahrain

Conflicts of Interest

Dr. Fedorowicz declares no relevant financial conflicts of interest.

Deputy Editor
Scott A. Barron MD, FAAP
KeyboardArrowDown
Affiliations

Deputy Editor of Pediatrics, Dynamed; Massachusetts, United States; Associate Professor of Pediatrics, University of Central Florida College of Medicine; Florida, United States

Conflicts of Interest

Dr. Barron declares no relevant financial conflicts of interest.

Images in topic (2)

View all
Asthma

Asthma

CheckCircle
Subscribe for unlimited access to DynaMed content.
Already subscribed? Sign in

top