Box 9.1.

Diagnosis of asthma in children

Symptoms and signs	Remarks
History of multiple attacks of SOB or wheezing in a season	More than 3 attacks/season, recurrent, and worse during sleep with triggers such as physical activity, laughing, crying, or exposure to tobacco smoke or air pollution
Coughing	More than 2 weeks, not related to URTI, recurrent, and worse during sleep with triggers such as activity, laughing, crying, or exposure to tobacco smoke or air pollution
Reduced activity	Not able to run, play, or laugh at the same intensity as other children and tires earlier during walks (wants to be carried)
Wheezing	Equal at both sides of the chest, during expiratory phase, especially on forced expiration
Atopy	Eczema, environmental/food sensitization
Family history	Atopy (allergic rhinitis, atopic dermatitis, food allergy) and asthma in the first-degree relative
Breath sounds	Prolonged expiratory phase
Therapeutic trial	Trial of short-acting bronchodilator or corticosteroid therapy
Spirometry	Typically, in children >6 years with bronchodilator response assessment
Chest X-ray	May be considered in infants to rule out congenital causes
Tests for hypersensitivity	Both skin testing or/and allergen-specific IgE blood testing

URTI: Upper respiratory tract infection, IgE: Immunoglobulin E