Diagnostic Challenges of Childhood Asthma
Journal of Clinical Immunology and Allergy is a world class open access journal intended to publish the cutting-edge research in the field of Immunology and Allergy.
Asthma affects all age groups and is the most common chronic disease in children. High rates of health care use are observed across age groups despite the long-term use of controller medications .For school-age children (5–18 years) in particular, extrapolating from the advances and benefits in asthma treatment that have occurred in adults can be slow because of differences in underlying respiratory physiology, immunopathology, the need for child and parent and caregiver education, and communication barriers. One of the current difficulties with the evidence base for asthma management in children is that, historically, much of the research has been performed in adults.
Pediatric patients experiencing relatively mild symptoms might not realize anything is wrong or be unable to adequately express their concerns.
Diagnosis of asthma in childhood is challenging. Both underdiagnosis and overdiagnosis of asthma are important issues. The present review gives information about challenging factors for an accurate diagnosis of childhood asthma.
Although underdiagnosis of asthma in childhood has always been the most important diagnostic problem, overdiagnosis of asthma has also been increasingly recognized. This is probably due to diagnosis of asthma based on symptoms and signs alone. Demonstration of variable airflow obstruction by lung function tests is the most common asthma diagnostic tests used in practice and is therefore strongly recommended in children who can cooperate. Recently, an asthma guideline combining the clinical and economic evidences with sensitivity and specificity of diagnostic procedures was developed to improve accuracy of diagnosis and to avoid overdiagnosis. This guideline provided an algorithmic clinical and cost-effective approach and included fractional exhaled nitric oxide measurement as one of the diagnostic tests in addition to lung function.
Diagnosis of asthma in children should be made by combining relevant history with at least two confirmatory diagnostic tests whenever possible. Diagnosis based on short-period treatment trials should be limited to young children who are unable to cooperate with these tests.
Alternative strategies that might improve pediatric asthma management and control include replacement of short-acting β2-agonist relievers by an inhaled corticosteroid plus a fast-acting β2-agonist (short-acting β2-agonist or fast- and long-acting β2-agonist) combination at Global Initiative for Asthma step 1 or 2 to ensure that patients receive an inhaled corticosteroid whenever they feel the need for symptomatic relief.
Such an approach could eliminate the problem of learned overuse or over-reliance on short-acting β2-agonist reliever medication and address the other challenges in current pediatric asthma management. Clinical studies in pediatric patients or large studies involving a proportion of pediatric patients are required to provide the supporting evidence needed to help advance such new approaches and improve asthma control from a pediatric perspective.
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Clinical Immunology and Allergy