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Misdiagnosis of asthma in schoolchildren
C L Yang1,2, E Simons3,4, R G Foty3
1Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Accurate asthma diagnosis in children is crucial. This study found that relying solely on clinical history leads to misdiagnosis, emphasizing the need for objective testing to confirm asthma in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Clinical Diagnosis Accuracy
- Asthma Management
Background:
- Accurate asthma diagnosis is essential for effective management.
- Few studies have evaluated the accuracy of physician-diagnosed asthma in children.
Purpose of the Study:
- To determine the accuracy of parent-reported physician-diagnosed asthma in children from a community cohort.
- To compare parent-reported diagnoses with a reference standard incorporating objective testing.
Main Methods:
- A nested case-control study involving 203 children aged 9-12.
- Participants were categorized into asthma cases, symptomatic controls, and asymptomatic controls.
- Asthma diagnosis was confirmed using spirometry, methacholine challenge, and allergy skin testing.
Main Results:
- Physician agreement on asthma diagnosis was moderate (kappa 0.46-0.81).
- 45% of asthma cases were overdiagnosed, and 10% of symptomatic controls were underdiagnosed.
- Parent-reported asthma diagnosis showed 75% sensitivity and 92% specificity.
Conclusions:
- Childhood asthma is frequently misclassified when diagnosis relies only on clinical history.
- Objective testing is vital for confirming asthma diagnoses in pediatric populations.
- This study underscores the limitations of clinical history alone in diagnosing pediatric asthma.
Background:
A correct diagnosis of asthma is the cornerstone of asthma management. Few pediatric studies have examined the accuracy of physician-diagnosed asthma.
Objectives:
We determined the accuracy of parent reported physician-diagnosed asthma in children sampled from a community cohort.
Methods:
Nested case-control study that recruited 203 children, aged 9-12, from a community-based sample. Three groups were recruited: asthma cases had a parental report of physician-diagnosed asthma, symptomatic controls had respiratory symptoms without a diagnosis of asthma, and asymptomatic controls had no respiratory symptoms. All participants were assessed and assigned a clinical diagnosis by one of three study physicians, and then completed spirometry, methacholine challenge, and allergy skin testing. The reference standard of asthma required a study physician's clinical diagnosis of asthma and either reversible bronchoconstriction or a positive methacholine challenge. Diagnostic accuracy, sensitivity and specificity were calculated for parent-reported asthma diagnosis compared to the reference standard.
Results:
One hundred two asthma cases, 52 controls with respiratory symptoms but no asthma diagnosis, and 49 asymptomatic controls were assessed. Physician agreement for the diagnosis of asthma was moderate (kappa 0.46-0.81). Compared to the reference standard, 45% of asthma cases were overdiagnosed and 10% of symptomatic controls were underdiagnosed. Parental report of physician-diagnosed asthma had 75% sensitivity and 92% specificity for correctly identifying asthma.
Conclusions:
There is significant misclassification of childhood asthma when the diagnosis relies solely on a clinical history. This study highlights the importance of objective testing to confirm the diagnosis of asthma. Pediatr Pulmonol. 2017;52:293-302. © 2016 Wiley Periodicals, Inc.
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