There is a wide variation in the clinical presentation of asthma, both in the symptoms, their severity, and how often they are present. The commonest features are a wheeze, a cough, difficulty in breathing (rapid and/or noisy breathing), tightness in the chest, and shortness of breath.
The wheeze may vary from mild to severe, and it can often be easily heard by parents. Sometimes, however, the child may appear to be breathing normally and quietly, but the doctor will hear signs of airway narrowing by listening to the child’s chest with a stethoscope. The wheeze may be particularly evident when the child is breathing out or exhaling. The wheeze may be present all the time, during a viral infection, or after exercise. It is often worse in the early morning or at night.
Many parents do not realise that coughing is just as much part of the clinical spectrum of asthma as is wheezing. Depending on the age of the child, the cough often sounds ‘fruity’, and older children may even cough up thick yellow sputum. The cough is particularly evident at night, and after physical exertion. Sometimes the cough results in restless sleep, and the child may wake frequently during the night. Often the cough gets in the way of the child participating in sporting activities at school. It must be emphasised that a child does not have to have a wheeze to be suffering from acute or chronic asthma — sometimes a cough is the only manifestation.
On other occasions, there may be neither a cough nor a wheeze, but the child may complain of tightness in the chest, of feeling tired or ‘off colour’, or may lose his appetite. The symptoms of asthma can be vague, and it is only after treatment that parents may notice the difference to their child’s general well-being.
There is also a wide spectrum in the severity and frequency of asthma. Some children wheeze or cough only several times a year, in association with a cold, while others (a small minority) may experience some symptoms every day. The child’s doctor will want to take a very careful history of the frequency and severity of the symptoms, for the treatment plan will be dictated by these two factors.
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