BMJ Best Practice Podcast Asthma in children
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Aug 21, 2025 Helen Brough, a Consultant in Paediatric Allergy at King’s College London, discusses the challenges of diagnosing asthma in children, emphasizing nocturnal cough as a key symptom. She outlines critical management strategies, including the use of inhaled corticosteroids and the necessity of recognizing triggers. The conversation touches on the impact of air pollution on rising asthma rates and the misconceptions about outgrowing the condition. Brough also highlights innovative solutions like smart inhalers to improve adherence and overall care.
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Core Definition And Triggers
- Asthma is a chronic inflammatory airway disorder with variable symptoms like wheeze, cough, chest tightness and shortness of breath.
- In children symptoms fluctuate and are commonly triggered by infections, allergens or environmental factors.
Diagnose Clinically Then Confirm
- Make the diagnosis clinically first using a characteristic history of variable, often nocturnal symptoms and trigger patterns.
- Then confirm with objective tests (spirometry or FeNO) from age 5 and repeat measurements over time.
Use Objective Tests Appropriately
- Use spirometry (≥12% FEV1 or 200 mL improvement) or FeNO (>35 ppb in children) to document reversible airflow obstruction or eosinophilic inflammation.
- Choose tests following local guideline preference (GINA vs BTS/NICE/SIGN) and age-appropriate limits.