Asthma in Children Clinical Practice Guidelines (ERS, 2021)

European Respiratory Society

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 30, 2021

Guidelines for the diagnosis of asthma in children aged 5–16 years were published in April 2021 by the European Respiratory Society (ERS) in European Respiratory Journal.[1]

The European Respiratory Society (ERS) recommends spirometry as first-line diagnosis in children aged 5–16 years with suspected asthma.

ERS recommends bronchodilator reversibility testing as first-line diagnosis in all children with FEV1 < LLN or < 80% predicted and/or FEV1/FVC < LLN or < 80% predicted.

ERS recommends FeNO as first-line diagnosis in children aged 5–16 years with suspected asthma.

ERS recommends against PEFR variability testing as the primary objective test on its own to diagnose asthma in children aged 5–16 years.

ERS recommends against diagnosing asthma in children aged 5–16 years based on clinical history alone or following a single abnormal objective test.

ERS recommends against using an improvement in symptoms after a trial of preventer medication alone to diagnose asthma in children aged 5–16 years.

ERS recommends against using skin prick tests as diagnostic tests for asthma in children aged 5–16 years.

ERS recommends a direct bronchial challenge test using methacholine in children aged 5–16 years with suspected asthma where asthma diagnosis could not be confirmed with first-line tests.

ERS recommends an indirect bronchial challenge test using a treadmill or a bicycle in children aged 5-16 years with suspected asthma with exercise-related symptoms where asthma diagnosis could not be confirmed with first-line tests.

For more information, go to Pediatric Asthma.

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