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The next step is a full physical examination to assess his asthma and to make sure that there is nothing else affecting the child. Many people believe that a doctor can tell all that is required of the child’s condition simply by taking his pulse, the respiration rate, or listening to his chest. In case of asthma, nothing could not be further from truth.The physical examination focuses on skin, eyes, ears, nose, throat, and chest. The doctor will look for signs of eczema or hives on the skin. Inflammation in the ears or eyes may be due to an underlying allergy. Dark circles under the eyes, or a swelling in the nose, are signs of allergic rhinitis, or hay fever, both associated with asthma. The doctor would also examine the throat, the tonsils, the abdomen for spleen and the liver. Occasionally, what appears to be asthma turns out to be something else. One of the chief functions of the examination is to make sure that other conditions do not escape unnoticed.The chest examination is the most important part of the physical examination. Using a stethoscope, the doctor will try to detect wheezing sound, if any. The doctor would also attempt to determine whether the air movement in and out of the chest is unhindered, or whether there is any airway obstruction, and the effect it may be having on the child’s health. The doctor may even ask the child to do light exercise to make it easier to detect the wheezing sound. Chronic and severe asthma in children tends to cause some loss of normal growth and the child should be weighed and measured regularly, and at each physical examination, to monitor normal growth.*47\260\8*

Possible causes which either augment the likelihood of developing asthma upon exposure to a trigger, or may even increase the susceptibility to getting an attack of asthma, are classified as contributing factors. They do not cause an allergic reaction, but their presence facilitates an allergic reaction.
Respiratory infections Air pollution Outdoor pollutants Indoor pollutants Cigarette Smoke Self smoking Physical exercise Weather
Emotional stress and psychological trauma Food and chemicals Occupational sensitizers
In an important study conducted in Athens, Greece, Dr Prititis and his colleagues examined the medical records of 974 asthmatic children aged 7-14 years in two children’s referral hospitals from 1975 to 1987. It was found that 68 per cent children had positive SPT (Skin Prick Test or Skin Scratch—Test. A positive family atopy history was more often accompained by positive SPT. Sensitization to grass pollens was noted with higher prevalence in urban areas. The house dust mite, Dermatophagoides Pteronyssimus, sensitisation was more prevalent in coastal areas which have high humidity and are therefore conducive for mite growth. The results supported the notion that there was a correlation between sensitivity to common antigens present in the environment, the kind of allergens and the genetic factor with regard to the development of atopic asthma. Environment significantly influences both the prevalence of asthma and the kind of allergens which trigger an asthma attack. Traditionally genetic factors were considered to be of prime importance in the sensitisation of asthmatics. Nevertheless, according to recent studies, environmental factors may play a more important role than previously thought, both in sensitisation, or in the development of atopic disease.
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