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Asthma in children younger than 12 years: Initial evaluation

and diagnosis
Authors: Gregory Sawicki, MD, MPH, Kenan Haver, MD
Section Editors: Robert A Wood, MD, Gregory Redding, MD
Deputy Editor: Elizabeth TePas, MD, MS

INTRODUCTION

Asthma is a significant health problem worldwide, and it is one of the most common chronic diseases
of childhood in many countries [1,2]. The prevalence in different countries ranges from 1 to 18
percent. In the United States, for example, over nine million children have been ever told they had
asthma, and 5.5 million still have asthma [3]. Establishing a diagnosis of asthma involves a careful
process of history taking, physical examination, and diagnostic studies. The differential diagnosis of
wheezing must be carefully considered, particularly in infants and very young children, for whom
testing for reversible airflow obstruction is not done routinely.

The epidemiology, initial evaluation, and diagnosis of childhood asthma are reviewed here. The
assessment of severity/control and monitoring, and treatment of childhood asthma are discussed
separately. (See "Asthma in children younger than 12 years: Overview of initiating therapy and
monitoring control" and "Asthma in children younger than 12 years: Management of persistent
asthma with controller therapies" and "Asthma in children younger than 12 years: Quick-relief
(rescue) treatment for acute symptoms".)

The pathogenesis, genetics, risk factors, and natural history of asthma are also reviewed separately.
(See "Pathogenesis of asthma" and "Genetics of asthma" and "Risk factors for asthma" and
"Wheezing phenotypes and prediction of asthma in young children" and "Natural history of asthma".)

EPIDEMIOLOGY

A wide global variation exists in the prevalence of asthma, with higher rates typically seen in higher-
income countries [4]. Asthma is the most common chronic disease in childhood in resource-rich
countries. A significant increase in the estimated prevalence of asthma was seen in resource-rich
countries in the 1980s and 1990s, with slower rates of increase in the 2000s and a plateau thereafter
[5]. Approximately 7.5 percent of US children had asthma in 2018, down from 9.4 percent in 2010 and
8.7 percent in 2001. However, asthma prevalence continues to increase in other countries such as
China [6]. Possible causes for the increase in asthma prevalence are reviewed in detail separately. (See
"Increasing prevalence of asthma and allergic rhinitis and the role of environmental factors".)

Prevalence rates for current asthma in children under age 18 years increased in the United States
from 2001 to 2009 (8.7 to 9.7 percent), then decreased, with a prevalence of 7.5 percent in 2018 [7,8].
Disparities in prevalence remained, with increasing prevalence seen in poor children and those living
in the Southern US and the highest prevalence still seen in Puerto Rican and non-Hispanic Black
American children, particularly for those living in urban environments. Before the onset of puberty,
boys have a higher current prevalence of asthma than girls (9.2 versus 7.4 percent) [3,9]. This trend
reverses in adolescence. Lifetime asthma prevalence for children was 12.7 percent in 2013 and 2016.
The prevalence of asthma appears to have plateaued in other countries as well [10-14].

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Literature review current through: May 2022. | This topic last updated: Feb 15, 2022.

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