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Asthma after childhood pneumonia: six year follow up study
C E Clark1, J M Coote, D A Silver
1Mid Devon Medical Practice, Witheridge, Devon EX16 8AH. ceclark@sol.co.uk
Insights
Many children hospitalized with pneumonia have undiagnosed or developing asthma. This study highlights the high prevalence of asthma in these pediatric patients, suggesting a need for better screening and treatment.
Area of Science:
- Pediatric respiratory medicine
- Epidemiology of childhood asthma
- Clinical diagnostics in children
Background:
- Pneumonia in children can sometimes mask or coexist with undiagnosed asthma.
- Understanding the long-term respiratory health of children post-pneumonia is crucial.
Purpose of the Study:
- To determine the cumulative prevalence of asthma in children hospitalized with pneumonia.
- To investigate if pneumonia admission is linked to undiagnosed asthma in children.
Main Methods:
- A prospective cohort study followed children previously hospitalized with pneumonia.
- Data collected via postal questionnaires to general practitioners and families.
- Confirmed pneumonia diagnoses through independent x-ray review.
Main Results:
- A 45% cumulative prevalence of asthma was observed in the cohort.
- A family history of asthma significantly increased the odds of an asthma diagnosis (OR 11.23).
- Children with asthma exhibited higher symptom scores, particularly those untreated.
Conclusions:
- A significant number of children hospitalized for pneumonia have undiagnosed or subsequently developed asthma.
- The high prevalence indicates the value of careful follow-up for these children.
- Asthma appears undertreated in this population, emphasizing the need for structured symptom assessment.
Objective:
To establish the long term cumulative prevalence of asthma in children admitted to hospital with pneumonia and to examine the hypothesis that some children admitted to hospital with pneumonia may be presenting with undiagnosed asthma.
Design:
Prospective study of a cohort of children previously admitted to hospital with pneumonia, followed up by postal questionnaires to their general practitioners and the children or their parents.
Setting:
General practices in southwest England.
Participants:
78 children admitted to the Royal Devon and Exeter Hospital between 1989 and 1991 with a diagnosis of pneumonia confirmed on independent review of x ray films.
Main Outcome Measures:
Any diagnosis of asthma, use of any treatment for asthma, and asthma symptom scores.
Results:
On the basis of a 100% response rate from general practitioners and 86% from patients or parents, the cumulative prevalence of asthma was 45%. A diagnosis of asthma was associated with a family history of asthma (odds ratio 11.23; 95% confidence interval 2.57 to 56.36; P=0.0002). Mean symptom scores were higher for all children with asthma (mean score 2.4; chi(2)=14.88; P=0. 0001) and for children with asthma not being treated (mean 1.4; chi(2)=6.2; P=0.01) than for those without asthma (mean 0.2).
Conclusions:
A considerable proportion of children presenting to a district general hospital with pneumonia either already have unrecognised asthma or subsequently develop asthma. The high cumulative prevalence of asthma suggests that careful follow up of such children is worth while. Asthma is undertreated in these children; a structured symptom questionnaire may help to identify and reduce morbidity due to undertreatment.