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Asthma - Management
How should I manage children with an intermediate probability of asthma who can perform airway obstruction tests?

  • Check for airway obstruction using spirometry:
    • Spirometry should be done by a trained healthcare professional; if this is not possible, seek advice.
  • If there is no evidence of airway obstruction, consider referring to secondary care for additional tests.
  • If there is evidence of airway obstruction, assess for reversibility to either bronchodilator therapy (e.g. salbutamol 400 micrograms via metred-dose inhaler and spacer) and/or to a trial of asthma treatment for 2–3 months:
    • If there is significant reversibility (greater than 12% increase in forced expiratory volume in 1 second [FEV1]) or clinical response to a trial of asthma treatment is good, a diagnosis of asthma is probable. Continue to treat as asthma.
    • If there is no significant reversibility (less than 12% increase in FEV1) and a trial of treatment is not beneficial, refer to secondary care for additional tests.
    • If it is unclear whether a child has improved on a trial of asthma treatment, careful observation during a trial of treatment withdrawal may clarify whether they have responded to asthma treatment.
Clarification / Additional information
  • The choice of asthma treatment (e.g. inhaled short-acting beta2-agonist or inhaled corticosteroid) depends on the severity and frequency of symptoms. For more information, see Starting asthma treatment.
  • Normal spirometry results obtained when the child is asymptomatic do not exclude a diagnosis of asthma. Repeated measurements of lung function may be more helpful to interpret than a single measurement.
Basis for recommendation
  • These recommendations are based on the British Guideline on the Management of Asthma: a national clinical guideline [SIGN and BTS, 2009].
    • In children, tests of airway obstruction (spirometry or measuring peak expiratory flow) may provide support for a diagnosis of asthma.
    • Spirographs require calibration to allow accurate interpretation of the results (e.g. Rosenthal normal values based on the child's sex and height). Healthcare professionals require training on how to calibrate and interpret the results from a spirogram. CKS recommend that advice should be sought regarding carrying out spirometry in children and interpreting the results, unless the healthcare professional has received appropriate training.

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