Basic diagnostic evaluation in the asthmatic child and adolescent in Primary Care

To establish the diagnosis of asthma, the clinician must determine that episodic symptoms of airflow obstruction are present, airflow obstruction is at least partially reversible and alternative diagnoses are excluded. Recommended mechanisms to establish the diagnosis are detailed medical history, physical exam focusing on the upper respiratory tract, chest and skin, and spirometry to demonstrate reversibility. Additional studies may be considered to evaluate alternative diagnoses, identify precipitating factors and assess the severity of asthma. Asthma often begins in childhood, and when it does, it is frequently found in association with atopy. A family history of atopy is the most important clearly defined risk factor for atopy in children. A maternal history of asthma and/or rhinitis is a significant risk factor for late childhood onset asthma. Markers of allergic disease at presentation (skin prick tests and peripheral blood markers) are related to severity of current asthma and persistence through childhood.