From the Guidelines
Asthma can be diagnosed at any age, but a definitive diagnosis is typically made around age 5-6 when children can reliably perform pulmonary function tests like spirometry. For children under 5, doctors typically make a presumptive diagnosis based on symptoms, family history, and response to asthma medications like albuterol 1. The European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years recommend spirometry, bronchodilator reversibility testing, and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma 1.
In younger children, the diagnosis of asthma is often based on a combination of clinical symptoms, such as wheezing, coughing, chest tightness, and shortness of breath, and a positive response to a trial of asthma medications 1. The Expert Panel Report 3 (EPR-3) guidelines for the diagnosis and management of asthma recommend considering a diagnosis of asthma in infants and young children who have had four or more episodes of wheezing in the past year, and who have a positive asthma predictive index 1.
The diagnosis process may include a trial of asthma medications to see if symptoms improve, and monitoring response to therapy closely to determine the need for continued daily long-term control therapy 1. A definitive diagnosis of asthma is crucial to ensure appropriate treatment and management, and to reduce the risk of morbidity and mortality associated with untreated or undertreated asthma. The age-based approach to diagnosis reflects the developmental challenges in younger children who cannot articulate symptoms clearly or perform the breathing tests needed for definitive diagnosis, while the underlying airway inflammation that characterizes asthma can be present from a very young age 1.
Key considerations in the diagnosis of asthma in children include:
- Clinical symptoms, such as wheezing, coughing, chest tightness, and shortness of breath
- Response to a trial of asthma medications
- Results of pulmonary function tests, such as spirometry
- Presence of a positive asthma predictive index
- Family history of asthma or other allergic diseases
- Presence of other allergic conditions, such as atopic dermatitis or allergic rhinitis.
By considering these factors and using a combination of clinical judgment and diagnostic testing, healthcare providers can make an accurate diagnosis of asthma in children and develop an effective treatment plan to manage symptoms and reduce the risk of morbidity and mortality.
From the FDA Drug Label
Use of fluticasone propionate and salmeterol inhalation powder 100 mcg/50 mcg in patients aged 4 to 11 years is supported by extrapolation of efficacy data from older subjects and by safety and efficacy data from a trial of fluticasone propionate and salmeterol inhalation powder 100 mcg/50 mcg in children with asthma aged 4 to 11 years The safety and effectiveness of fluticasone propionate and salmeterol inhalation powder in children with asthma younger than 4 years have not been established.
The age at which you can diagnose asthma is not directly stated in the label, but it can be treated with fluticasone propionate and salmeterol inhalation powder in patients aged 4 years and older. For children younger than 4 years, the safety and effectiveness of this medication have not been established 2.
From the Research
Asthma Diagnosis Age
- Asthma can be diagnosed at various ages, with different phenotypes and incidence rates observed across different age groups 3.
- According to a study published in Respiratory medicine, the incidence of asthma diagnosis peaks in young boys (0-9 years) and middle-aged women (40-49 years), with an average incidence rate of 2.2/1000/year 3.
- Another study published in The Journal of allergy and clinical immunology found that the mean age at asthma diagnosis decreased from 4.7 years in 1993 to 2.6 years in 2000, with a higher risk of asthma diagnosis in the first 3 years of life for children born after 1996 4.
Age-Specific Incidence
- Adult-diagnosed asthma, defined as a physician-diagnosis of asthma made at ≥ 18 years of age, accounts for 63.7% of subjects with physician-diagnosed asthma, with 58.4% of men and 67.8% of women reporting adult-diagnosed asthma 3.
- The incidence of asthma diagnosis varies by age and gender, with adult-diagnosed asthma becoming the dominant phenotype among those with physician-diagnosed asthma by age 50 in men and 38 in women 3.
- In children, the age at asthma diagnosis has decreased over time, with a significant increase in asthma incidence and a decrease in the age of asthma diagnosis across multiple birth cohorts 4.