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  • Dr. Tara Dawn MD CCFP

Guideline change alert: Diagnosing asthma in kids


SHORT ANSWER MANAGEMENT QUIZ:

  1. Name two (2) clinical characteristic features of airflow obstruction.

  2. True or False: Asthma CANNOT be diagnosed before the age of six, due to inability to complete Pulmonary Function Tests (PFTs).

  3. Yes / no: Is a personal/family history of atopy required to make the diagnosis of asthma?

  4. Name one (1) class of medication used for acute management of an asthma exacerbation.

In 2015, the Canadian Pediatric Society and the Canadian Thoracic Society released a position paper suggesting that we now did not have to wait until a patient could participate formal pulmonary function testing. Thus, we could start correctly and confidently diagnosing asthma in our preschool population, or age less than 6 years old.

No longer should we be labeling and diagnosing patients with ‘Reactive Airway Disease’ or ‘Wheezy Bronchitis’!!! They suggested that we should consider ‘asthma’ as a diagnosis in children 1 – 5 years old if:

  • Frequent (>8 days/month) of asthma-like symptoms

  • Recurrent (>2) exacerbations of asthma-like signs.

The diagnosis is made in preschoolers if history (from parents) or examination reveals:

  • Clinical signs of airflow obstruction

  • Reversibility of airflow obstruction using short-acting B2-agonists

  • Absence of alternative diagnosis

EXAM TIP: On a SOO exam, when it comes to management of Asthma don’t stop at a simple prescription for SABA or ICS; remember for all Asthma patients make sure to mention the creation of an ‘Asthma Action Plan’, Collaboration with Respiratory Therapy and Asthma Support Groups and/or Referral to Pediatrician or Respirologist.

ANSWERS:

  1. Clinical Characteristics of Airflow Obstruction: Wheezing, difficulty breathing, cough

  2. False, Asthma CAN be diagnosed in the preschool age children based on clinical presentation and history.The diagnosis can be made if health care providers can observe direct improvement with short-acting B2-agonists (SABA) during an acute attack, or if convincing parental report of symptomatic response to a three-month therapeutic trial of medium dose inhaled corticosteroid.

  3. Personal history of atopy (ie. Food Allergy or eczema) or family history should raise your suspicion of asthma, but are not necessary.

  4. Short-Acting B2-agonists (SABA)

References: http://www.cps.ca/en/documents/position/asthma-in-preschoolers


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