Signs and symptoms of asthma are not the same with everyone, and they may be mistaken for signs of other common childhood illnesses. Several studies show that as many as 50 to 80 percent of children with asthma develop symptoms before their fifth birthday.

• Asthma is frequently not diagnosed correctly. This causes many infants and young children to receive improper treatments.
• Not all wheezes and coughs are caused by asthma, so treatment using asthma medicines is not always right.
• Frequent fits of coughing, with or without wheezing, are almost always caused by asthma.
• Coughing may be the child’s only symptom of asthma. Wheezing may or may not be present.

It may be asthma if:

There is a history of repeated

• Coughing
• Wheezing
• Shortness of breath or fast breathing
• Chest tightness

Symptoms are made worse by:

• Viral infection
• Smokes (tobacco, wood, etc.) or other irritants (like strong perfumes or odors)
• Exercise or active playing
• Things the child is allergic to, such as pollen or animal fur
• Changes in weather/humidity
• Crying or laughing

Take a good medical history of the child, including:

• Symptoms
• coughing
• wheezing
• chest tightness
• Symptom patterns
• Seasonal, continual, etc.
• With exercise or active playing
• At night, early morning
• Laughing/crying
• With triggers
• Severity
• Absences from school?
• Extra doctor visits?
• ED visits? Hospitalizations?
• Characteristics of the child’s home
• Triggers and/or aggravating factors
• Development of disease and current treatment
• Age of onset and diagnosis
• History of early-life injury to airways (e.g. respiratory infections, parental smoking)
• Comorbid conditions (e.g. rhinitis, eczema)
• Family history of allergies and asthma
• Progress of the disease (better or worse)
• Profile of typical exacerbation
• Impact of asthma on child and family
• >Episodes of unscheduled care
• Life-threatening exacerbations
• Absences from/interruptions of school or other activities
• Activity limitations, especially physical activities
• History of nighttime awakening with symptoms
• Effect on growth, development, behavior and school performance, impact on family routines/dynamics/economics
• Daycare/school characteristics that may interfere with adherence to treatment
• Present management and response, including plans for managing exacerbations, need for oral corticosteroids (and frequency of use)
• The child’s and family’s perceptions of disease
• Child and parent perception and belief about asthma and medications to treat asthma
• Ability of child and parents to cope with disease, and to recognize the severity of an attack

Do a complete physical exam, looking for:

• Wheezing, which may or may not be present with asthma
• Signs that the child has trouble breathing, including hyperexpansion of the thorax, use of accessory muscles, tachypnea
• Signs of other allergic diseases, including atopic dermatitis/eczema, clear nasal discharge, swelling of and/or pale nasal mucosa

Children with asthma may need additional tests to aid and/or confirm the diagnosis.

• Bronchoprovocation with cold air, methacholine, or exercise (if negative, may rule out asthma)
• Child has symptoms (coughing, wheezing, breathlessness, chest tightness), but spirometry is (near) normal
• Assess diurnal variation of PEF over 1-2 weeks