When a child reports breathlessness but saturation is normal, there is no wheeze, and spirometry or peak flow is normal during symptoms, asthma may not be the explanation. Dysfunctional breathing, exercise-induced laryngeal obstruction and deconditioning are common alternatives, and they do not respond to more inhaled steroid.
Objective confirmation of asthma before escalating treatment protects children from unnecessary drug exposure.
- Measure saturation and peak flow or spirometry during symptoms where possible.
- Ask whether symptoms come on with exercise and settle quickly at rest.
- Note inspiratory noise during exercise, which suggests laryngeal obstruction.
- Review inhaler technique and adherence before stepping up.
Why it matters
Escalating steroid doses for the wrong diagnosis adds side effects without benefit.
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