Diagnose Asthma

Asthma is a difficult illness to diagnose especially in a young child. This is mainly due to three reasons.

The first reason is that in a young child, infection of the lungs like bronchitis can mimic asthmatic attacks. The main difference is the cause � infections are caused by germs (eg. viruses, bacteria), while asthmatic attacks are allergic reactions to a variety of possible triggers. Often, doctors can only diagnose asthma based on the history given by a child's caregiver. For example, if your son gets wheezing attacks very often especially if it is not associated with fever, and if your son responds well to nebulizer therapy, then it is likely he is asthmatic.

The second reason is that an asthmatic child can have a range of different symptoms. Children who are mildly asthmatic may have 1-2 attacks of breathlessness and wheezing a year, and get better with treatment. Some may have persistent symptoms in between attacks that may include chronic cough like your son. Children who are severe asthmatics will have more frequent attacks (eg. monthly) and are often symptomatic even in between attacks. If your child is asthmatic, it is important to profile the severity of his asthma so that your doctor can tailor his treatment accordingly. Children with mild asthma are usually treated with reliever therapy during their acute attacks. Children with severe asthma, or with persistent symptoms in between their attacks have a preventer therapy added to their treatment regime. Preventer therapy needs to be taken daily and used long term usually for months. It is an important component of their therapy as uncontrolled asthma in these children can be life threatening.

The third reason as pointed out by you is that sensitive nose (allergic rhinitis) can often cause persistent coughing, which may mimic asthma. In addition, some children may have both sensitive nose, and asthma.

Both your children have significant risk factors of having asthma � family history, presence of sensitive nose, and eczema. My advice is for you to find a doctor you are comfortable with to follow up with your children in the long term. If your children are indeed asthmatic, their story will unfold as they grow up. Start keeping a diary of your children's hospital admissions, visits to the doctors, and medication history. This will help your doctor diagnose and manage asthma.