Paediatric Asthma Diagnostic Approach

Table 1: Probability-Based Approach of Asthma

Probability of asthma:	Low	Moderate	High
Duration of symptoms (cough, wheeze, heavy breathing) during URTI	< 10 days	> 10 days	> 10 days
Number of exacerbations	2-3 per year	>3 per year, or severe episodes	>3 per year, or severe episodes
Interval symptoms (between episodes or exacerbations)	No symptoms	Occasional cough or wheeze	Cough and/or wheeze during play/laughing/exercise
Atopy	Nil	Nil	Present
Family history of asthma	Nil	Nil	Present

Some pointers:

For high probability of asthma, a therapeutic trial of low to moderate dose ICS for at least 6 weeks may be commenced and clinical improvement with preventer treatment and worsening of symptoms when treatment is stopped is suggestive of asthma.
For low probability of asthma, evaluate for other diagnosis.
For intermediate probability of asthma, watchful waiting or a diagnostic trial of low dose of ICS for 3 months and assess response.

Table 2: Modified Asthma Predictive Index (mAPI)

Four or more wheeze episodes per year with at least 1 major OR 2 minor criteria

4 or more wheeze episodes per year

Major criteria (0 selected)

Parental history of asthmaAtopic eczema (doctor diagnosed)Aero-allergen sensitisation

Minor criteria (0 selected)

Eosinophilia (>4%)Wheeze unrelated to coldsAllergic sensitisation to food i.e. milk, egg, peanuts

Red flags and pointers of other diagnosis:

Failure to thrive
Neonatal or very early onset of symptoms
Vomiting/feeding problems with respiratory symptoms
Chronic wet cough (> 4 weeks)
Fixed monophonic wheeze/stridor
Failure to respond to controller medications
No association of symptoms with typical triggers (e.g. URTI)
Focal / asymmetrical lung findings
Cardiovascular signs
Finger clubbing
Hypoxaemia outside context of acute illness

Table 3: Evaluation of the Background of Newly Diagnosed Asthma

For each row, click the value that best matches the patient. Overall severity is set by the single most severe parameter selected, not an average or majority — the standard convention for this kind of staging table (matches GINA/NAEPP-style asthma severity classification), not stated verbatim in the source.

Day symptoms

Night waking

Exacerbation

Exercise/activity symptoms

FEV1 / PEFR

This division is arbitrary and the groupings may merge. An individual patient's classification may change from time to time.
There are patients with infrequent but severe or life-threatening attacks with completely normal lung function and no symptoms between episodes.
PEFR = Peak Expiratory Flow Rate; FEV1 = Forced Expiratory Volume in 1 Second.

Table 4: Asthma Symptoms Control

In the past 4 weeks, has the patient had:

Daytime asthma symptoms more than 2x/week?

Any night waking due to asthma?

Reliever needed for symptoms more than 2x/week? (Excluding pre-exercise use)

Any activity limitation due to asthma?

Answer all 4 questions to see the result.