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Asthma in children younger than 12 years: Initial evaluation and diagnosis

Gregory Sawicki, MD, MPH
Kenan Haver, MD
Section Editors
Robert A Wood, MD
Gregory Redding, MD
Deputy Editor
Elizabeth TePas, MD, MS


Asthma is a significant health problem worldwide, and it is one of the most common chronic diseases of childhood in many countries [1,2]. The prevalence in different countries ranges from 1 to 18 percent. In the United States, for example, asthma affects more than seven million children [3]. Establishing a diagnosis of asthma involves a careful process of history taking, physical examination, and diagnostic studies. The differential diagnosis of wheezing must be carefully considered, particularly in infants and young children, for whom testing for reversible airflow obstruction is not feasible.

The initial evaluation and diagnosis of childhood asthma are reviewed here. The epidemiology, pathology, and pathophysiology; assessment of severity/control and monitoring; and treatment of childhood asthma are discussed separately. (See "Asthma in children younger than 12 years: Epidemiology and pathophysiology" and "Asthma in children younger than 12 years: Initiating therapy and monitoring control" and "Asthma in children younger than 12 years: Treatment of persistent asthma with controller medications" and "Asthma in children younger than 12 years: Rescue treatment for acute symptoms".)


The history in a child with suspected asthma centers on the presence of symptoms, typical symptom patterns, precipitating factors or conditions (ie, atopy), and asthma risk factors (table 1).

Additional history that should be obtained in a child with established asthma who presents for disease monitoring includes previous and current therapy (controller and quick-relief medication use), exposure to triggers, utilization of healthcare services (emergency department [ED], hospital, unscheduled clinic visits), school attendance and performance, and participation in physical activity. Review of an asthma questionnaire such as the Asthma Control Test may provide additional useful information. (See "Asthma in children younger than 12 years: Initiating therapy and monitoring control", section on 'Assessment of control'.)

The evaluation of a child who presents with an acute asthma exacerbation is discussed separately. (See "Acute asthma exacerbations in children: Emergency department management".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2016.
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