Table 3 Solutions to the challenges in the diagnosis of asthma in children
Solution | Explanation | Sources |
|---|---|---|
1. Community education and destigmatising asthma | ||
 1a. Community education | Recommended school-based curriculum and peer driven education programmes to increase perception and recognition of asthma symptoms | Temitayo et al. [47] |
 1b. Community and school-based screening programmes for childhood asthma | Set up community and school-based screening programmes for childhood asthma and referral to care | |
2. Asthma diagnostic terms | ||
 2a. Asthma diagnostic terms | Diagnostic terms like ‘wheezing disorder, the asthma syndrome, episodic viral wheeze, multiple-trigger wheeze’ for children below the age of 5 years allows for trial medication to be given until objective diagnostic re-evaluation using spirometry at 5 years of age | Nantanda et al. [22], Masekela et al. [20], Ostergaard et al. [49] |
 2b. Redefinition of WHO IMCI algorithms for pneumonia to include fever | Need for revision of WHO IMCI guidelines to include ‘fever’ to ‘cough’ and ‘fast breathing’ to differentiate pneumonia from asthmatics who may not have fever | Nantanda et al. [22] |
 2c. Asthma should be considered a strong differential diagnosis for pneumonia | Asthmatic children likely to present several times with cough wheeze and shortness of breath | Nantanda et al. [22] |
3. Guideline development and implementation | ||
 3a. Guideline development and implementation | Guidelines are effective in improving asthma diagnosis, management and outcomes in primary health-care (PHC) clinics | du Plessis et al. [50] |
 3b. Evidence based guidelines | Need to exclude all other causes of wheeze, therapeutic trial of inhaled steroids may be useful where objective spirometry is not available Based on evidence, a four step diagnostic process was developed | Masekela et al. on behalf of South African Child Asthma Working Group [20], van Niekerk et al. [51] |
 3c. Symptom-based asthma diagnosis | Simple symptom-based questionnaires have been found to be useful in asthma diagnosis in children under 5 years | Nantanda et al. [52] |
4. Health systems strengthening | ||
 4. Health systems strengthening | Investigated the use of the Practical Approach to Care Kit for Children (PACK) kit which comprise a clinical decision support tool, diagnostic algorithms, training programme and health system strengthening with health-worker supervision, regular updates and policy change. Based on this investigation, a strategy to optimise the use of PACK was proposed and may act as the basis of improving asthma diagnosis and care in addition to other acute and chronic childhood illnesses | Murdoch et al. [53] |
 a. Accessibility to health care | Primary health care (PHC) is key in improving asthma diagnosis in resource poor settings | du Plessis et al. [50] |
 b. Health worker education | Training health workers at all levels of the health system | Murdoch et al. [53] |
 c. Capacitation of health facilities with diagnostic equipment and asthma drugs | Need for innovative confirmatory tests for childhood asthma for children under 5 years of age | Nantanda et al. [22] |
| Â | Availing spirometry to confirm asthma diagnosis. Training health workers on use of spirometry | Ayuk et al. [35], Desalu et al. [38], Nwosu et al. [42], Obaseki et al. [43], Adeyeye et al. [54], Masekela et al. [55] |