Table 4.

Specific questions to ask when assessing children 6–11 years with asthma.

Asthma symptom control
Day symptoms	Ask: How often does the child have cough, wheeze, dyspnea or heavy breathing (number of times per week or day)? What triggers the symptoms? How are they handled?
Night symptoms	Cough, awakenings, tiredness during the day? (If the only symptom is cough, consider other diagnoses such as rhinitis or gastroesophageal reflux disease).
Reliever use	How often is reliever medication used? (check date on inhaler or last prescription) Distinguish between pre-exercise use (sports) and use for relief of symptoms.
Level of activity	What sports/hobbies/interests does the child have, at school and in their spare time? How does the child’s level of activity compare with their peers or siblings? How many days is the child absent from school? Try to get an accurate picture of the child’s day from the child without interruption from the parent/carer.
Risk factors for adverse outcomes
Exacerbations	Ask: How do viral infections affect the child’s asthma? Do symptoms interfere with school or sports? How long do the symptoms last? How many episodes have occurred since their last medical review? Any urgent doctor/emergency department visits? Is there a written action plan? Risk factors for exacerbations include a history of exacerbations, poor symptom control, poor adherence and poverty, and persistent bronchodilator reversibility even if the child has few symptoms.
Lung function	Check curves and technique. Main focus is on FEV1 and FEV1/FVC ratio. Plot these values as percent predicted to see trends over time.
Side-effects	Check the child’s height at least yearly, as poorly controlled asthma can affect growth, and growth velocity may be lower in the first 1–2 years of ICS treatment. Ask about frequency and dose of ICS and OCS.
Treatment factors
Inhaler technique	Ask the child to show how they use their inhaler. Compare with a device-specific checklist.
Adherence	Is there any controller medication in the home at present? On how many days does the child use their controller in a week (e.g. 0, 2, 4, 7 days)? Is it easier to remember to use it in the morning or evening? Where is inhaler kept – is it in plain view to reduce forgetting? Check date on inhaler.
Goals/concerns	Does the child or their parent/carer have any concerns about their asthma (e.g. fear of medication, side-effects, interference with activity)? What are the child’s/parent’s/carer’s goals for treatment?
Comorbidities
Allergic rhinitis	Itching, sneezing, nasal obstruction? Can the child breathe through their nose? What medications are being taken for nasal symptoms?
Eczema	Sleep disturbance, topical corticosteroids?
Food allergy	Is the child allergic to any foods? (confirmed food allergy is a risk factor for asthma-related death)
Obesity	Check age-adjusted BMI. Ask about diet and physical activity.
Other investigations (if needed)
2-week diary	If no clear assessment can be made based on the above questions, ask the child or parent/carer to keep a daily diary of asthma symptoms, reliever use and peak expiratory flow (best of three) for 2 weeks (Appendix Chapter 4).
Exercise challenge (laboratory)	Provides information about airway hyperresponsiveness and fitness (Box 1–2). Only undertake a challenge if it is otherwise difficult to assess asthma control.

Source: Box 2–3 in GINA 2022. Box and appendix numbers refer to GINA 2022 report. Reproduced with permission from ref. ¹¹.

FEV₁ forced expiratory volume over 1 s, FVC forced vital capacity, ICS inhaled corticosteroid, OCS oral corticosteroid.