Diagnosing asthma in children under 5

This content is from the BTS, NICE and SIGN guideline - Asthma: diagnosis, monitoring and chronic asthma management, (SIGN 245), 2024.

Diagnosis is hard in this age group because it is difficult to do the tests and there are no good reference standards.

 

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1.3.1. For children under 5 with suspected asthma, treat with inhaled corticosteroids in line with the recommendations on medicines for initial management in children under 5, and review the child on a regular basis. If they still have symptoms when they reach 5 years, attempt objective tests (see the section on objective tests for diagnosing asthma in adults, young people and children aged 5 to 16).

[NICE 2017]

 

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1.3.2 If a child is unable to perform objective tests when they are aged 5:

  • try doing the tests again every 6 to 12 months until satisfactory results are obtained
  • refer for specialist assessment if the child’s asthma is not responding to treatment.

[NICE 2017, BTS/SIGN 2019, BTS/NICE/SIGN amended 2024]

 

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1.3.3 Refer to a specialist respiratory paediatrician any preschool child with an admission to hospital, or 2 or more admissions to an emergency department, with wheeze in a 12-month period.

[BTS/NICE/SIGN 2024]