The role of objective tests to support a diagnosis of asthma in children

Paediatr Respir Rev. 2020 Feb;33:52-57. doi: 10.1016/j.prrv.2019.02.001. Epub 2019 Feb 28.


In many healthcare settings asthma in children is a clinical diagnosis based on parental reported symptoms. These include intermittent episodes of wheezing, breathlessness and periodic nocturnal dry cough. Increased symptoms often coincide with colds. Confirming a diagnosis of asthma in children can be difficult and recent reports highlight that misdiagnosis, including over- and under-diagnosis of asthma are common. Recent UK National Institute of Health and Care Excellence guidelines recommend diagnostic algorithms for children from five years and adults to support a clinical suspicion of asthma. Spirometry, bronchodilator reversibility and fractional exhaled nitric oxide testing are the first line tests to diagnose asthma in children. The introduction of these tests across all healthcare settings has the potential to reduce misdiagnosis, improve asthma management and reduce healthcare spending for asthma.

Keywords: Asthma; Child; Diagnosis; FeNO; Spirometry; Wheeze.

Publication types

  • Review

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / therapeutic use
  • Asthma / diagnosis*
  • Asthma / drug therapy
  • Asthma / physiopathology
  • Breath Tests / methods*
  • Bronchodilator Agents
  • Child
  • Diagnostic Errors
  • Forced Expiratory Volume
  • Humans
  • Nitric Oxide / metabolism
  • Peak Expiratory Flow Rate
  • Practice Guidelines as Topic
  • Sensitivity and Specificity
  • Spirometry / methods*
  • Spirometry / standards
  • United Kingdom
  • Vital Capacity


  • Adrenal Cortex Hormones
  • Bronchodilator Agents
  • Nitric Oxide