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Medical Author:

Girish Sharma, MD

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Diagnosing asthma can be difficult and time-consuming because different children with asthma can have very different patterns of symptoms. For example, some kids cough at night but seem fine during the day, while others seem to get frequent chest colds that don't go away.

To establish a diagnosis of asthma, a doctor rules out every other possible cause of a child's symptoms. The doctor asks questions about the family's asthma and allergy history, performs a physical exam, and possibly orders laboratory tests (see Tests Used to Diagnose Asthma). Be sure to provide the doctor with as many details as possible, no matter how unrelated they might seem. In particular, keep track of and report the following:

• Symptoms: How severe are the attacks, when and where do they occur, how often do they occur, how long do they last, and how do they go away?
• Allergies: Does the child or anyone else in the family have any history of allergies?
• Illnesses: How often does the child get a cold, how severe are the colds, and how long do they last?
• Triggers: Has the child been exposed to irritants and allergens, has the child experienced any recent life changes or stressful events, and do any other things seem to lead to a flare?

This information helps the doctor understand a child's pattern of symptoms, which can then be compared to the characteristics of different categories of asthma (see below).

The criteria for a diagnosis of asthma are

• airflow into the lungs is reduced periodically (due to narrowed airways),
• the symptoms of reduced airflow are at least partially reversible,
• other diseases and conditions are ruled out.

Categories of asthma

The severity of asthma is classified based on how often the symptoms occur and how bad they are, including symptoms that happen at night, the characteristics of episodes, and lung function. These classifications do not always work well in children because lung function is difficult to measure in younger children. Also, children often have asthma that is triggered by infections, and this kind of asthma does not fit into any category. A child's symptoms can be categorized into one of four main categories of asthma, each with different characteristics and requiring different treatment approaches.

• Mild intermittent asthma: Brief episodes of wheezing, coughing, or shortness of breath that occur no more than twice a week is called mild intermittent asthma. Children rarely have symptoms between episodes (maybe just one or two flare-ups per month involving mild symptoms at night). Mild asthma should never be ignored because, even between flares, airways are inflamed.
• Mild persistent asthma: Episodes of wheezing, coughing, or shortness of breath that occur more than twice a week but less than once a day is called mild persistent asthma. Symptoms usually occur at least twice a month at night and may affect normal physical activity.
• Moderate persistent asthma: Symptoms occurring every day and requiring medication every day is called moderate persistent asthma. Nighttime symptoms occur more than once a week. Episodes of wheezing, coughing, or shortness of breath occur more than twice a week and may last for several days. These symptoms affect normal physical activity.
• Severe persistent asthma: Children with severe persistent asthma have symptoms continuously. Episodes of wheezing, coughing, or shortness of breath are frequent and may require emergency treatment and even hospitalization. Many children with severe persistent asthma have frequent symptoms at night and can handle only limited physical activity.

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