Otumdi Omekara, MD., MPAHA - Member of Society of Physician Entrepreneurs
Asthma is the most important chronic disease in US children. It accounts for up to 48,% of ER visits and 34% of hospitalizations per year. Seventy five percent of childhood asthma is allergic with onset mostly before the age of five. After obtaining clinical history that is suggestive of acute asthmatic attack, the physician proceeds to physically examine the child for confirmatory signs.
It is hard to miss the symptoms and signs of an acute asthmatic attack. The expiratory wheeze is audible without a stethoscope, except when the airflow is almost down to zero. Breathlessness or shortness of breath is noticeable with intercostal recessions on expiration. The sound of coughing is also quite evident. Sputum production may be noticeable in an older child, while infants tend to drool or sound croaky.
The trapped air in the lungs gives the child's chest a barrel or bloated shape due to increased lung volume. The desperate look and irritability are noticeable. An infant will pause frequently while breastfeeding, with soft and short cries. Poor feeding results from the frequent interruptions. There might be weight loss from poor feeding, rapid breathing,; and labored breathing. There might be flaring of the nasal opening (alae nasi). In very severe asthmatic attacks, with drastic reduction in oxygen content of blood, the patient may turn blue in the face and limbs (blue bloater)
If the attack was triggered by infection, the body temperature may be higher than normal. Depending on the type of infection, there might be white spots or whiting coating inside the mouth. The erythrocyte sedimentation rate (ESR) may also be raised because of the infection. A throat swab culture and sensitivity could grow some bacterial. The oxygen saturation test result will also be lower than normal at about 70-85%. Chest shows increased anterior-posterior diameter of the chest due to the increased lung volume.
A child who is able to blow into a spirometer for lung function test will record an abnormal Q/V (ventilation perfusion) and FEV1/FVC (Forced Expiratory Volume/Forced Vital Capacity) ratios. The Forced Expiratory Volume in the first minute (FEV1) is measured by having the patient take a normal breath and blow with normal effort into a spirometer for a minute. The forced vital capacity is measured by having the patient take a deep breath and forcefully blow into a spirometer.
Sorting through these signs to make a diagnosis could be tricky in children who tend to have attacks at night and look well during the day. Such kids are the ones the doctor has to depend a lot on the test results to determine their risk of an imminent flare-up attack that calls for preventive measures. Otherwise there are so many signs and symptoms for the diagnosis of asthma in children that it can hardly be missed. For more of similar articles visit
Author: Otumdi. Omekara, MD., MPAHA
PO Box 91221, Portland OR, 97291
Dr. Otumdi Omekara is a preventive/business medicine specialist and medical publisher with over two decades of clinical practice experience and over a decade of provider management experience. His passion for patient education drives his medical content article writing and publishing. He was a health educator at Oregon DHS Center for Disease Control from 2001 to 2002. Prior to that he volunteered at NE Portland Neighborhood Clinic as a health educator from 1997 to 2002. Since 2002 he has been the Medical Publisher at Drotumdio Health Publications (dHp).