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. 1992 Dec;42(365):501–503.

Diagnosis and treatment of asthma in children: usefulness of a review of medical records.

R G Neville 1, F P Bryce 1, F M Robertson 1, I K Crombie 1, R A Clark 1
PMCID: PMC1372140  PMID: 1297369

Abstract

In order to tackle the problems of underdiagnosis and undertreatment of asthma in childhood general practitioners need to be aware of which children in their practices have or might have asthma. In an effort to identify a cohort of asthmatic or potentially asthmatic children a trained audit facilitator studied all the medical records of children aged between one year and 15 years who were registered with 12 Tayside general practices. From a total of 10,685 medical records the frequency of 'key items' sometimes associated with asthma were as follows: one or more episodes of bronchospasm or wheeze 23.7% of children, persistent cough 23.2%, treatment with anti-asthma therapy in the past 20.0%, exercise induced cough or wheeze 5.2% and history of 'wheezy bronchitis' 4.6%. However, in only 896 children (8.4%) had a formal diagnosis of asthma been made. Of all the children, 5.4% had received a prescription for anti-asthma medication within the past three months. Only 1.2% were taking an inhaled corticosteroid and 1.0% sodium cromoglycate, but many more were taking inhaled bronchodilators (3.1%) and oral bronchodilators (1.7%). The findings suggest that a systematic review of medical records by a trained facilitator can identify those children who could benefit from clinical review. Practices who wish to know which of their children have or might have asthma should consider using medical record review to search for key items associated with asthma.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson H. R. Trends and district variations in the hospital care of childhood asthma: results of a regional study 1970-85. Thorax. 1990 Jun;45(6):431–437. doi: 10.1136/thx.45.6.431. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ayres J. G. Trends in asthma and hay fever in general practice in the United Kingdom 1976-83. Thorax. 1986 Feb;41(2):111–116. doi: 10.1136/thx.41.2.111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Burney P. G., Chinn S., Rona R. J. Has the prevalence of asthma increased in children? Evidence from the national study of health and growth 1973-86. BMJ. 1990 May 19;300(6735):1306–1310. doi: 10.1136/bmj.300.6735.1306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Charlton I., Charlton G., Broomfield J., Mullee M. A. Audit of the effect of a nurse run asthma clinic on workload and patient morbidity in a general practice. Br J Gen Pract. 1991 Jun;41(347):227–231. [PMC free article] [PubMed] [Google Scholar]
  5. Charlton I., Charlton G., Broomfield J., Mullee M. A. Evaluation of peak flow and symptoms only self management plans for control of asthma in general practice. BMJ. 1990 Dec 15;301(6765):1355–1359. doi: 10.1136/bmj.301.6765.1355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gellert A. R., Gellert S. L., Iliffe S. R. Prevalence and management of asthma in a London inner city general practice. Br J Gen Pract. 1990 May;40(334):197–201. [PMC free article] [PubMed] [Google Scholar]
  7. Hay I. F., Higenbottam T. W. Has the management of asthma improved? Lancet. 1987 Sep 12;2(8559):609–611. doi: 10.1016/s0140-6736(87)92995-3. [DOI] [PubMed] [Google Scholar]
  8. Heijne den Bak J. Prevalence and management of asthma in children under 16 in one practice. Br Med J (Clin Res Ed) 1986 Jan 18;292(6514):175–176. doi: 10.1136/bmj.292.6514.175. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hill R. A., Standen P. J., Tattersfield A. E. Asthma, wheezing, and school absence in primary schools. Arch Dis Child. 1989 Feb;64(2):246–251. doi: 10.1136/adc.64.2.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hill R., Williams J., Britton J., Tattersfield A. Can morbidity associated with untreated asthma in primary school children be reduced?: a controlled intervention study. BMJ. 1991 Nov 9;303(6811):1169–1174. doi: 10.1136/bmj.303.6811.1169. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jones A., Sykes A. The effect of symptom presentation on delay in asthma diagnosis in children in a general practice. Respir Med. 1990 Mar;84(2):139–142. doi: 10.1016/s0954-6111(08)80017-0. [DOI] [PubMed] [Google Scholar]
  12. Levy M., Parmar M., Coetzee D., Duffy S. W. Respiratory consultations in asthmatic compared with non-asthmatic children in general practice. Br Med J (Clin Res Ed) 1985 Jul 6;291(6487):29–30. doi: 10.1136/bmj.291.6487.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Neville R. Case finding of asthma patients. Practitioner. 1990 Apr 22;234(1487):417–418. [PubMed] [Google Scholar]
  14. Robertson C. F., Heycock E., Bishop J., Nolan T., Olinsky A., Phelan P. D. Prevalence of asthma in Melbourne schoolchildren: changes over 26 years. BMJ. 1991 May 11;302(6785):1116–1118. doi: 10.1136/bmj.302.6785.1116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Speight A. N., Lee D. A., Hey E. N. Underdiagnosis and undertreatment of asthma in childhood. Br Med J (Clin Res Ed) 1983 Apr 16;286(6373):1253–1256. doi: 10.1136/bmj.286.6373.1253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Toop L. J. Active approach to recognising asthma in general practice. Br Med J (Clin Res Ed) 1985 Jun 1;290(6482):1629–1631. doi: 10.1136/bmj.290.6482.1629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Usherwood T. P. Factors affecting estimates of the prevalence of asthma and wheezing in childhood. Fam Pract. 1987 Dec;4(4):318–321. doi: 10.1093/fampra/4.4.318. [DOI] [PubMed] [Google Scholar]

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