Using child reported respiratory symptoms to diagnose asthma in the community

Association of immigrant generational status with asthma

OBJECTIVE

We sought to examine whether asthma risk is lower in second-generation immigrants (i.e., Canadian-born children with at least one foreign-born parent) and first-generation immigrants (i.e., foreign-born children) compared with non-immigrants (i.e., Canadian-born children to Canadian-born parents).

METHODS

Data were obtained from the Canadian National Longitudinal Survey of Children and Youth from 1994 to 2008, which measured child health and developmental factors from birth to early adulthood. The sample included 15,799 participants aged 2-26 years. Asthma was defined as diagnosis by a health professional as having asthma, having wheezing or whistling in the chest, or use of medication for asthma.

RESULTS

Prevalence of asthma (defined as a combination of any three factors) was lower in first-generation (32%) and second-generation (34%) immigrants compared with non-immigrants (46%). After controlling for covariates, first- and second-generation immigrants had 0.21 (AOR = 0.21; 95% CI = 0.07-0.67) and 0.19 (AOR = 0.19; 95% CI = 0.09-0.39) lower odds of reporting asthma compared with non-immigrants, respectively. For every year the parent(s) of second-generation immigrants resided in Canada, the odds for asthma increased by 5% (AOR = 1.05; 95% CI = 1.02-1.06).

CONCLUSION

Immigrant children and youth in Canada, regardless of whether they are first- or second-generation, have lower odds for asthma compared with non-immigrants.

Correlation of respiratory symptoms and spirometric lung patterns in a rural community setting, Sindh, Pakistan: a cross sectional survey

BACKGROUND

Symptom-based questionnaires can be a cost effective tool enabling identification and diagnosis of patients with respiratory illnesses in resource limited setting. This study aimed to determine the correlation of respiratory symptoms and spirometric lung patterns and validity of ATS respiratory questionnaire in a rural community setting.

METHODS

This cross sectional survey was conducted between January - March 2009 on a sample of 200 adults selected from two villages of district Khairpur, Sindh, Pakistan. A modified version of the American thoracic society division of lung disease questionnaire was used to record the presence of respiratory symptoms. Predicted lung volumes i.e. forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and their ratio (FEV1/FVC) were recorded using portable spirometer.

RESULTS

In the study sample there were 91 (45.5%) males and 109 (54.5%) females with overall mean age of 34 years (±11.69). Predominant respiratory symptom was phlegm (19%) followed by cough (17.5%), wheeze (14%) and dyspnea (10.5%). Prevalence of physician diagnosed and self-reported asthma was 5.5% and 9.5% respectively. Frequency of obstructive pattern on spirometry was 28.72% and that of restrictive pattern was 19.68%. After adjustment for age, gender, socioeconomic status, spoken dialect, education, smoking status, height, weight and arsenic in drinking water, FVC was significantly reduced for phlegm (OR 3.01; 95% CI: 1.14 - 7.94), wheeze (OR 7.22; 95% CI: 2.52 - 20.67) and shortness of breath (OR 4.91; 95% CI: 1.57 - 15.36); and FEV1 was significantly reduced for cough (OR 2.69; 95% CI: 1.12 - 6.43), phlegm (OR 3.01; 95% CI: 1.26 - 7.16) and wheeze (OR 10.77; 95% CI: 3.45 - 33.6). Presence of respiratory symptoms was significantly associated with restrictive and/or obstructive patterns after controlling for confounders. Similar findings were observed through linear regression where respiratory symptoms were found to be significantly associated with decrements in lung volumes. Specificity and positive predictive values were found to be higher for all the symptoms compared to sensitivity and negative predictive values.

CONCLUSION

Symptoms based respiratory questionnaires are a valuable tool for screening of respiratory symptoms in resource poor, rural community setting.

Computer-aided intelligent system for diagnosing pediatric asthma

Asthma is a lung chronic inflammatory disorder estimated between 1.4% and 27.1% in different area of the world. Result of various studies show that asthma is usually underdiagnosed especially in developing countries, because of limitations on access to medical specialists and laboratory facilities. In this paper, we report on the development and evaluation of a novel patient-based fuzzy system that promotes the diagnosis method of asthma. The design of this application addresses five critical issues included: 1) modular representation of asthma diagnostic variables regard to patients' perception of the disease, 2) algorithmic approaches conducting inference of diagnosing based on patient's response to questions, 4) front-end mechanism for capturing data from patient, 5) output for both patient and physician regard to asthma possibility. for the system output score (0-10) the efficacy of this system calculated in the study sample included 139 asthmatic patients and 139 non-asthmatic patients (age range 6-18) reinforce the sensitivity of 88% and specificity of 100% for cut off value 0.7.

A comparison of parent-reported wheezing or shortness of breath among infants as assessed by questionnaire and physician-interview: The Generation R study

PURPOSE

The prevalence of asthma symptoms among preschool children is difficult to determine with accuracy because no gold standard is available for diagnosis. The aim of this study was to compare parent-reported wheezing or shortness of breath among infants as assessed by questionnaire and physician-interview.

METHODS

We studied 1,202 children participating in the Generation R study. Their parents completed a written questionnaire at home when the infant was 12 months old, including items on wheezing or shortness of breath. During the regular free-of-charge youth healthcare visit at age 14 months, the physician interviewed the parents to assess the presence of wheezing or shortness of breath.

RESULTS

The prevalence of wheezing or shortness of breath estimated from questionnaire was significantly higher than from physician-interview (36% vs. 20%; P < 0.001): observed agreement 73% (kappa 0.36). Only 41% of questionnaire-reported symptoms were assessed through the physician-interview, while 73% of physician-interviewed symptoms were reported in the questionnaire. Compared with infants in the subgroup with agreement on the presence of wheezing or shortness of breath, the infants in the subgroups without agreement significantly less often received anti-asthma medication and significantly less often had abnormal respiratory sounds or bronchiolitis or croup, and their mothers were significantly less often working. The proportion of infants receiving anti-asthma medication was higher in interview-data compared with questionnaire-data (22.7% vs. 3.9%; P < 0.001).

CONCLUSIONS

Questionnaire yielded higher prevalence rates for wheezing or shortness of breath than physician-interview. Physician-reported symptoms are associated with a higher proportion of infants receiving anti-asthma medication. Parent-reported asthma symptoms should be confirmed by pediatricians whenever possible.

Increased rate and greater severity of allergic reactions to insect sting among schoolchildren with atopic diseases

The question of whether atopic diseases are a risk factor for allergic reactions to insect sting is still unresolved. The aim of this study was to evaluate the association between atopic diseases (asthma, allergic rhinitis, atopic eczema) and allergic reactions to insect stings among schoolchildren in Israel. A self-report questionnaire of the International Study of Asthma and Allergies in Childhood was administered to a national sample of 13-14-yr-old schoolchildren. Questions regarding reactions to insect stings were added. A total of 10,021 questionnaires were available for analysis. Among the children who reported insect stings (56.3%), the prevalence of current asthma was 6.0%, of allergic rhinitis, 10.5%, and of atopic eczema, 8.7%, with no significant differences from the whole study population. Among children with any of the atopic diseases, 36.9% reported an allergic reaction to insect sting compared to 24.8% of the non-atopic children (p < 0.0001). On multivariate analysis, asthma, allergic rhinitis, and atopic eczema were found to be significant risk factors for allergic reactions of any severity. Children in the atopic group had a significantly higher rate of severe allergic reactions than the non-atopic children, and relatively higher rates of milder ones (p < 0.0001). Asthmatic patients with severe allergic reactions had more parameters of severe asthma than asthmatic patients with mild or no reactions. In conclusions, allergic diseases are associated with a higher rate and greater severity of allergic reactions to insect sting in children. The severity of the allergic reaction is related to the severity of the asthma symptoms.

Differing reports of asthma symptoms in African Americans and Caucasians

OBJECTIVE

This pilot study explores the reported symptoms in African Americans and Caucasians with asthma.

METHODS

Asthma patients in an inner-city pulmonary clinic were given a brief questionnaire of asthma symptoms and the BORG scale, followed by spirometry.

RESULTS

African Americans were less likely to report nocturnal awakenings (67% vs. 100%; p = 0.037), complain of dyspnea (33% vs. 75%; p = 0.038), or experience chest pain (13% vs. 75%; p = 0.002) than Caucasians.

CONCLUSIONS

This is the first study to demonstrate that there are clinically significant differences in the reporting of asthma symptoms between African Americans and Caucasians.

Descriptors and perception of dyspnea in African-American asthmatics

OBJECTIVE

This study explores self-reported perception of asthma symptoms in African-Americans.

METHODS

Qualitative methodology was used to analyze the responses from African-Americans within focus groups from Nashville, Tennessee.

RESULTS

Common symptoms were chest tightness, "breathing problems," and wheeze. Less commonly reported symptoms included cough, chest pain, dizziness, sweating, and "short of breath." A single participant reported nocturnal wheezing.

CONCLUSIONS

This study provides insight into the descriptors and perception of asthma symptoms in African-Americans. Understanding the descriptors of symptoms and disease severity in African-American patients may lead to more accurate diagnosis, treatment, and reduced mortality within this high-risk population.

Is the prevalence of wheeze in children altered by neonatal BCG vaccination?

BACKGROUND

The prevalence of asthma and atopic disease has increased in recent decades, but precise reasons for this increase are unknown. BCG vaccination is thought to be among a group of vaccines capable of manipulating the immune system toward T(H)1 dominance and therefore reducing the likelihood of atopic disease.

OBJECTIVE

The aim of this study was to determine the influence of neonatal BCG vaccination on the prevalence of wheeze in a large community population of children.

METHOD

In a historical cohort study, a parent-completed questionnaire was used to identify the prevalence of wheeze in BCG-vaccinated and nonvaccinated children in Manchester, England.

RESULTS

There were 2414 participants aged between 6 and 11 years. In a univariate analysis neonatal BCG vaccination was associated with a significantly lower prevalence of wheeze (odds ratio, 0.69; 95% CI, 0.55-0.86), and statistical significance was retained when the analysis was adjusted for potential confounders (odds ratio, 0.68; 95% CI, 0.53-0.87).

CONCLUSION

These results demonstrate an association between asthma symptom prevalence and neonatal BCG vaccination, relating to a possible 27% reduction in prevalence, and are therefore of considerable public health importance.

CLINICAL IMPLICATIONS

The capacity of neonatal BCG vaccination to reduce the prevalence of respiratory symptoms in children warrants further investigation.

Comparison of clinically diagnosed asthma with parental assessment of children's asthma in a questionnaire

Epidemiological evaluations of the prevalence of asthma are usually based on written questionnaires (WQs) in combination with validation by clinical investigation. In the present investigation, we compared parental assessment of asthma among their preschool children in response to a WQ with the corresponding medical records in the same region. An International Study of Asthma and Allergies in Childhood (ISAAC)-based WQ was answered by 75% of the parents of 6295 children aged 1-6 yr. Clinically diagnosed asthma, recorded in connection with admissions to the hospital or a visit to any of the outpatient clinics in the same region, were analysed in parallel. Finally, a complementary WQ was sent to the parents of children identified as asthmatic by either or both of this approaches. In response to the WQ 5.9% were claimed to suffer from asthma diagnosed by a doctor. According to the medical records, the prevalence of clinically diagnosed asthma was 4.9%. The estimated prevalence among children requiring treatment for their asthma was 4.4%. The sensitivity of the WQ was 77%, the specificity 97.5%. In the 1-2 yr age group the sensitivity was only 22%. This WQ was able to identify 54% of the children with a medical record of asthma. Forty percent of the children claimed by their parents to be asthmatic had no medical record of asthma. An ISAAC-based parentally completed WQ provided an acceptable estimation of the prevalence of asthma in children 2-6 yr of age, although only half of the individual patients identified in this manner are the same as those identified clinically.

Evaluation of severity of bronchial asthma through an exercise bronchial challenge

Optimum treatment of bronchial asthma requires accurate diagnosis and severity classification. We studied the use of an exercise bronchial challenge in the asthmatic patient as a diagnostic tool. An exercise bronchial challenge test was carried out in 431 asthmatic children and 114 children without a history of asthma in a moderate-altitude environment (2,230 m above sea level/7,314 feet above sea level). Values of peak expiratory flow (baseline and maximum fall) were analyzed through time in each asthma severity group (intermittent, mild persistent, moderate persistent, severe persistent, and nonasthmatic controls). There was a significant difference among responses of asthma severity groups for almost all variables. No difference was found between nonasthmatic and intermittent groups who had similar behavior, except in bronchodilator response. An exercise bronchial challenge helps classify a patient according to asthma severity; it is easy to reproduce and does not require expensive equipment. It allows diagnosing and classifying asthma severity easily and supplementing the clinical evaluation. Based on our results, we propose a fall of PEF >or= 11% as new cutoff point for making a diagnosis of persistent bronchial asthma. A fall of 11-25% indicates mild persistent asthma; from 25-50%, moderate persistent asthma; and a bigger fall, severe persistent asthma.

The child with asthma at school: results from a national asthma survey among schoolchildren in Israel

PURPOSE

To evaluate school absence and restriction in school activities of children with asthma, and to estimate the involvement of the school staff in asthma disabilities.

METHODS

A modified version of the International Study of Asthma and Allergies in Childhood written questionnaire was administered to a national sample of 13-14-year-old schoolchildren across Israel. Questions regarding social and demographic factors, school absence owing to asthma symptoms, and school staff involvement were added.

RESULTS

There were 10,057 complete questionnaires available for analysis; 710 children reported having asthma. Children with asthma were absent on the average 7.3 +/- 9.8 days in the past school year compared with 3.9 +/- 6.3 days in children without (p = .0001). Absenteeism owing to respiratory symptoms was significantly more common in children with asthma and associated with a more severe asthmatic condition. Four percent of the children with asthma were absent from school more than 30 days. Of the children reporting asthma, 25.9% were not allowed to participate in one or more school activities for medical reasons, compared with 4.2% of children without asthma. Of the children with asthma, 44.3% reported that the school nurse knew about their asthma, and only 13.8% reported that the nurse discussed their asthmatic condition with them; 38.2% of children with asthma reported that no one at school knew about their illness.

CONCLUSIONS

Children with asthma are absent annually on average 3.4 days more than children without asthma. School absence is associated with the severity of asthma. A significant percentage of asthmatic children participate less in school activities. School staff awareness of the children illness is not satisfactory.

Respiratory symptoms and hamsters or other pets: a large-sized population survey in Saitama Prefecture

BACKGROUND: Keeping hamsters as pets has been increasing markedly. Clinical reports have suggested that hamster or other pet ownership is associated with respiratory symptoms. However, this association has not been fully investigated by population-based studies in Japan. The aim of the present study was to investigate the relationship between hamster ownership and respiratory symptoms by using a questionnaire.

METHODS: During the period of August 1 to 20, 2002, we conducted a cross-sectional survey in Saitama Prefecture, which has a total population of approximately 7 million. First, we selected, proportionally to the population size, 100 areas from 5 administration districts of Saitama Prefecture. From each area, 30 households were chosen: 15 living in detached houses and 15 living in other types of dwelling, such as apartment houses. In this way, 2 groups based on type of dwelling (detached house versus other types) could be studied. A lay away plan was carried out. For the survey, 2 questionnaires were developed. One was a questionnaire dealing with household conditions, including pet keeping. The other sought details regarding individual health and lifestyle conditions. The questionnaire dealing with respiratory symptoms asked “whether the respondents had experienced respiratory symptoms (wheezing and/or breathlessness and/or bad cough) in the last 12 months.”

RESULTS: The response rate was 78.9%. There were 7,395 respondents in 2,368 households. There was no association between either dog or cat ownership and respiratory symptoms. In contrast, hamsters kept in the home were positively associated with respiratory symptoms. In a multivariate logistic regression analysis, hamster ownership increased the odds ratio for respiratory symptoms (odds ratio: 1.57; 95% confidence interval: 1.18-2.10).

CONCLUSION: This large size population-survey indicated that hamster ownership is associated with respiratory symptoms.