Continuing Medical Education

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

R Masekela, S M Risenga, O P Kitchin, D A White, G Davis, P Goussard, A I Manjra, F E Kritzinger, M Levin, H Zar, R J Green; on behalf of the South African Childhood Asthma Working Group (SACAWG)

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.

 


Authors' affiliations

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

S M Risenga, Department of Pulmonology and Allergy, Faculty of Health Sciences, Polokwane/Mankweng Campus, University of Limpopo, Polokwane, South Africa

O P Kitchin, Private Practice, Netcare Waterfall City Hospital, Johannesburg, South Africa

D A 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

A I Manjra, Private Practice, Life Westville Hospital, Durban, South Africa

F E 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

R J Green; on behalf of the South African Childhood Asthma Working Group (SACAWG), Steve Biko Academic Hospital and Department of Paediatrics and Child Health, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

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Keywords

Paediatrics; Asthma; Diagnosis; South Africa; Review

Cite this article

South African Medical Journal 2018;108(7):540-545. DOI:10.7196/SAMJ.2018.v108i7.13165

Article History

Date submitted: 2018-06-26
Date published: 2018-06-26

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