The Diagnosis and Definition of Childhood Asthma

Abstract

Bronchial asthma is one of the most common chronic diseases in childhood. The incidence is stated to be between 2% and 10%. These large differences are due firstly to the different definitions used, and secondly to the fact that the disease is, unfortunately, still not recorded adequately (Speight et al. 1983). Bronchial asthma is defined as a respiratory tract obstruction occurring mainly spasmodically and arising from increased reactivity of the bronchial system to various exogenous and endogenous stimuli. This part of the definition is more or less generally accepted. However, disagreement exists concerning the question whether the definition which is becoming more widely used in English-speaking countries is correct, that bronchial asthma is any acute or recurrent obstructive lung disease in the first year of life. In German-speaking countries the attempt is being made to distinguish between obstructive bronchitis, formerly called “spastic”, “asthmoid” or “wheezing bronchitis”, and asthma. The advantage of the Anglo-American definition is that the children are referred for the correct anti-asthmatic therapy at an early stage. This also brings about a critical re-evaluation and the possible termination of anti-asthmatic therapy initiated earlier. A poll conducted in 1984 by the “Swiss Parents Association for Children with Asthma and Allergies”, in 136 families with an asthmatic child, is also inclined in favour of the Anglo-American definition. According to the poll, the first symptoms appeared in the first year of life in 48.6% of children and the first asthmatic attack occurred in 16.8% of children before they were one year old. However, obstructive bronchitis recurring twice or three times can be regarded as a certain manifestation of bronchial asthma (Wenner 1976).