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Biological, psychological and social complexities in childhood development
Biological, psychological and social complexities in childhood development

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1.1 Assessment & diagnosis

Assessment and diagnosis of asthma in children 5–16 years of age is slightly different to the process for adults. Before the age of 5 years, it is difficult to confirm asthma as a diagnosis (National Institute for Health and Care Excellence, 2020). The next activity will allow you to explore the assessment and diagnostic process for children and young people.

Activity 2 Guidance on assessment and diagnosis of asthma

Timing: Allow 60 minutes

You will need to access the National Institute for Clinical Health and Care Excellence (NICE) [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] for these activities. To avoid losing your place in the course, if you are studying on a desktop you should open the link in a new tab or window by holding down Ctrl (or Cmd on a Mac) when you click on it. If you are studying on a mobile device hold down the link and select to ‘Open in New Tab’. Return here when you have finished.

Once you have access to the NICE guidelines, make sure you follow the guidance for children and young people.

Part A

Using the guidance document answer the following questions.

1. What is involved in the initial clinical assessment?

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Discussion

From Section 1.1.1:

Take a structured clinical history in people with suspected asthma. Specifically, check for:

  • wheeze, cough or breathlessness, and any daily or seasonal variation in these symptoms
  • any triggers that make symptoms worse
  • a personal or family history of atopic disorders. 
(National Institute for Health and Care Excellence, 2020)

Algorithm A is a flowchart that outlines clinical assessment. (See section 1.1.1.)

2. What are ‘objective tests’?

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Discussion

These are ‘tests carried out to help determine whether a person has asthma, the results of which are not based on the person’s symptoms, for example, tests to measure lung function or evidence of inflammation’ (National Institute for Health and Care Excellence, 2020).

3. Why should symptoms alone not be used as an objective test?

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Discussion

Symptoms alone should not be used to diagnose asthma as they could give a false diagnosis of asthma. This would mean that the incorrect treatment could be prescribed. If people with asthma are misdiagnosed as not having asthma this could increase the risk of an asthma attack.

Do not use symptoms alone without an objective test to diagnose asthma.

Do not use a history of atopic disorders alone to diagnose asthma. (See sections 1.1.2 and 1.1.3 of the article.)

4. What is different about diagnosing children under the age of 5 compared to those over the age of 5?

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Discussion

For children under 5 with suspected asthma, treat symptoms based on observation and clinical judgement, and review the child on a regular basis (see the section on pharmacological treatment pathway for children under 5). If they still have symptoms when they reach 5 years, carry out objective tests (see the section on objective tests for diagnosing asthma in adults, young people and children aged 5 and over and Algorithm B) (Section 1.2.1 of the article).

Part B

Using the NICE guidance document ‘Algorithm B Objective tests for asthma in children and young people aged 5-16’ and the information provided for each of the three children below, make a decision about whether these children would be likely to have asthma.

Child A

Girl holding book to chest and smiling

Observation

  • Normal spirometry with a negative bronchodilator reversibility test
  • FeNO: 13 ppb
  • Peak flow readings: 250, 245, 240

a. 

Diagnose asthma


b. 

Consider alternative


c. 

Suspect asthma and review


d. 

Other


The correct answer is b.

b. 

The peak flow does not vary and the FeNO is lower than 35 ppb.


Child B

Girl walking whilst eating ice cream

Observation

  • Spirometer: not known
  • FeNO: not known
  • Peak flow readings: unable to obtain

a. 

Diagnose asthma


b. 

Consider alternative


c. 

Suspect asthma and review


d. 

Other


The correct answer is d.

d. 

NICE (2020) Section 1.2.2 states:

If a child is unable to perform objective tests when they are aged 5:

continue to treat based on observation and clinical judgement

try doing the tests again every 6 to 12 months until satisfactory results are obtained

consider referral for specialist assessment if the child repeatedly cannot perform objective tests and is not responding to treatment. 


Child C

Young boy smiling into camera

Observation

  • Normal spirometry with a negative bronchodilator reversibility test
  • FeNO: 37 ppb
  • Peak flow readings: 120, 110, 115

a. 

Diagnose asthma


b. 

Consider alternative


c. 

Suspect asthma and review


d. 

Other


The correct answer is a.

a. 

The peak flow is variable and the FeNO is over 35 ppb.