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Active approach to recognising asthma in general practice
Insights
A study of children born in 1977 found 8% diagnosed with asthma. Further analysis revealed 6% had exercise-induced asthma and 3% showed clinically significant airway obstruction, highlighting the need for active diagnosis.
Area of Science:
- Pediatrics
- Respiratory Medicine
- General Practice
Background:
- Asthma diagnosis in children can be challenging in general practice settings.
- Underdiagnosis of pediatric asthma may lead to delayed treatment and poorer outcomes.
Purpose of the Study:
- To investigate the prevalence of diagnosed and undiagnosed asthma in a cohort of children.
- To evaluate the utility of exercise testing and specific symptoms in identifying pediatric asthma.
Main Methods:
- Retrospective review of general practice medical records for 214 children born in 1977.
- Exercise testing was performed on children suspected of having undiagnosed asthma based on a scoring system.
- Analysis of symptom combinations (atopic eczema, cough, wheezing) for predictive value.
Main Results:
- A diagnosis of asthma was recorded in 8% (18/214) of the children.
- Exercise testing identified exercise-induced asthma in 6% (12/214) of the cohort.
- An additional 3% (7/214) had symptoms and borderline exercise tests indicating significant airway obstruction.
- Combinations of atopic eczema, nocturnal cough, persistent cough, and wheezing predicted asthma in over 50% of cases.
Conclusions:
- A significant proportion of pediatric asthma cases may remain undiagnosed in general practice.
- Active case-finding using exercise testing and symptom analysis is necessary and feasible.
- Improved diagnostic strategies can enhance the timely identification and management of childhood asthma.
Abstract:
The general practice medical records of 214 children born in 1977 were scrutinised for a diagnosis of asthma. In 18 (8%) of these a diagnosis of asthma had been entered. Using a scoring system based on the medical record a further group of children who were thought likely to have undiagnosed asthma was exercise tested. Twelve children (6%) had demonstrable exercise induced asthma. In addition, seven children (3%) had both frequent respiratory symptoms and borderline exercise test results, indicating that they too had clinically important airways obstruction. As expected, histories of atopic eczema, nocturnal cough, persistent cough (more than one week), and wheezing appeared often in the medical records of the children with asthma. In combinations these diagnostic clues were more than 50% predictive of asthma. A more active approach in general practice to the diagnosis of asthma in children is both necessary and possible.