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Clinical characteristics of childhood asthmatics in Johannesburg
Insights
Cough is the most common symptom in Caucasian childhood asthma, often leading to misdiagnosis. Allergic rhinitis is prevalent, and many children experience delayed asthma diagnosis.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Epidemiology
Background:
- Childhood asthma presentation varies significantly across different ethnic and geographic populations.
- Accurate diagnosis and timely management of pediatric asthma are crucial for long-term health outcomes.
Purpose of the Study:
- To delineate the clinical characteristics of Caucasian children with asthma in Johannesburg.
- To facilitate a comparative analysis with Black asthmatic children in Soweto.
Main Methods:
- Prospective study design utilizing investigator-administered questionnaires.
- Data collection included presenting symptoms, triggers, co-existing diagnoses, allergy history, and 'delay to diagnosis'.
- Allergen sensitivity was assessed using skin-prick tests (SPTs).
Main Results:
- Cough was the predominant symptom (97.4%), followed by wheeze (77.3%).
- Upper respiratory tract infections and exercise were common triggers; allergic rhinitis was highly prevalent (88.2%).
- A significant delay in diagnosis was observed, with 50% of children diagnosed after age 4 symptomatic for over 3 years.
Conclusions:
- Cough as a primary symptom may contribute to asthma misdiagnosis and other respiratory diagnoses.
- High prevalence of atopy, particularly allergic rhinitis, underscores its role in childhood asthma.
- Similarities and differences in presentation between Caucasian and Soweto children suggest potential influences of environmental and care-giving factors.
Objectives:
To describe the clinical features of Caucasian childhood asthmatics in Johannesburg in order to compare these with a similar population of black asthmatic children resident in Soweto.
Design:
In a prospective study, a history was obtained by means of an investigator-administered questionnaire.
Main Outcome Measures:
Presenting asthma symptoms, precipitants of symptoms, concomitant diagnoses, individual and family background of allergy and 'delay to diagnosis' of asthma (age at symptom onset subtracted from age at diagnosis) from history and allergen sensitivity as assessed by skin-prick tests (SPTs).
Results:
Of the 468 (297 boys) asthmatics studied, 456 (97.4%) presented with cough, 362 (77.3%) with wheeze, 286 (61.1%) with a tight chest and 277 (59.2%) with breathlessness. Cough as sole symptom occurred in 102 (21.8%) while only 8 (1.7%) wheezed and did not cough. Commonest symptom triggers were upper respiratory tract infections and activity/exercise. An individual atopic background was common-allergic rhinitis in 413 (88.2%)-as was a family history of atopy, present in 390 (83.3%). Prolonged symptomatic periods occurred in most patients before asthma was diagnosed (among children diagnosed after the age of 4 years, 50% had been symptomatic for more than 3 years). 'Delay to diagnosis' was not influenced by presenting symptoms or by previous hospitalisation for asthma. Other respiratory diagnoses of bronchitis and pneumonia were common, possibly because of misdiagnosis. Commonest allergens on SPT were corn pollen, Bermuda and 5-grass mix, and standardised mites. Aside from wheat, food allergy was uncommon.
Conclusions:
Cough was the commonest presenting symptom despite its still being regarded as a less classic symptom of asthma that may account for misdiagnosis and a high frequency of other respiratory diagnoses. Associated allergy, especially allergic rhinitis, occurred frequently. Many aspects of presentation in whites were similar to those in Soweto children, although the latter had a more frequent concomitant diagnosis of tuberculosis, and recognised dust and cold weather as more frequent triggers. Differences might be influenced by the care-giving situation.