The diagnosis of asthma in children: An evidence-based approach to a common clinical dilemma

  • R Masekela
  • SM Risenga
  • OP Kitchin
  • DA White
  • G Davis
  • P Goussard
  • AI Manjra
  • FE Kritzinger
  • M Levin
  • H Zar
  • RJ Green

Abstract

Background. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The diagnosis of asthma in young children is limited by the inability to perform objective lung function testing in this group of patients and the wide variety of conditions that can phenotypically present with asthma-like symptoms. Objectives. To provide an evidence-based approach for clinicians to accurately diagnose asthma in young children and to assess the level of control to guide therapeutic decisions. Methods. The South African Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The asthma diagnosis and control task groups reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system, providing recommendations based on current evidence. Conclusions. Asthma in young children should only be diagnosed if all other causes of wheezing have been considered and excluded, and if there is a response to a therapeutic trial and worsening with withdrawal of asthma medication. Asthma control should be assessed at each visit to guide therapeutic decisions.

S Afr Med J 2018

Author Biographies

R Masekela
Inkosi Albert Luthuli Central Hospital and Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
SM Risenga
Department of Pulmonology and Allergy, Faculty of Health Sciences, Polokwane/Mankweng Campus, University of Limpopo, Polokwane, South Africa
OP Kitchin
Private Practice, Netcare Waterfall City Hospital, Johannesburg, South Africa
DA White
Charlotte Maxeke Academic Hospital and Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
G Davis
Private Practice, Greenside, Johannesburg, South Africa
P Goussard
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
AI Manjra
Private Practice, Life Westville Hospital, Durban, South Africa
FE Kritzinger
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Netcare Christiaan Barnard Memorial Hospital, Cape Town, South Africa
M Levin
Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa
H Zar
Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa
RJ Green
Steve Biko Academic Hospital and Department of Paediatrics and Child Health, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
Published
2018-08-02
Section
Articles

Journal Identifiers


eISSN: 0256-95749
print ISSN: 2078-5135