Skip to main content
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2004 Jun;89(6):544–548. doi: 10.1136/adc.2003.033688

Using child reported respiratory symptoms to diagnose asthma in the community

I Yu 1, T Wong 1, W Li 1
PMCID: PMC1719948  PMID: 15155400

Abstract

Aims: To study how respiratory symptoms reported by children, with or without spirometry, could help to discriminate those with asthma from those without.

Methods: Respiratory symptoms (frequent cough, frequent phlegm, and wheezing) reported by 1646 schoolchildren (aged 8–12 years) in a respiratory questionnaire and the FEV1:FVC ratio measured with spirometry (at three different cut-off values of 0.70, 0.75, and 0.80) were compared against the criterion standard of a physician diagnosis of asthma reported by the parents.

Results: The overall prevalence of asthma was 6%; more boys had asthma. Wheezing had the best discriminating ability among the three symptoms and a cut-off point at 75% was best for the FEV1:FVC ratio. Combining wheezing with an FEV1:FVC ratio <75% gave the highest discriminating ability of 83%. If the tests were applied to hypothetical populations with higher prevalence ratios of asthma, the added value of the FEV1:FVC ratio became less apparent.

Conclusion: Respiratory symptoms, especially wheezing, reported by children had good discriminating ability for asthma and could be adopted for opportunistic screening in the primary care settings.

Full Text

The Full Text of this article is available as a PDF (101.7 KB).

Selected References

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

  1. Agertoft L., Pedersen S. Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. Respir Med. 1994 May;88(5):373–381. doi: 10.1016/0954-6111(94)90044-2. [DOI] [PubMed] [Google Scholar]
  2. Biggerstaff B. J. Comparing diagnostic tests: a simple graphic using likelihood ratios. Stat Med. 2000 Mar 15;19(5):649–663. doi: 10.1002/(sici)1097-0258(20000315)19:5<649::aid-sim371>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  3. Boner A. L., Piacentini G. L., Bonizzato C., Dattoli V., Sette L. Effect of inhaled beclomethasone dipropionate on bronchial hyperreactivity in asthmatic children during maximal allergen exposure. Pediatr Pulmonol. 1991;10(1):2–5. doi: 10.1002/ppul.1950100102. [DOI] [PubMed] [Google Scholar]
  4. Burr M. L. Diagnosing asthma by questionnaire in epidemiological surveys. Clin Exp Allergy. 1992 May;22(5):509–510. doi: 10.1111/j.1365-2222.1992.tb00158.x. [DOI] [PubMed] [Google Scholar]
  5. Charlton I., Jones K., Bain J. Delay in diagnosis of childhood asthma and its influence on respiratory consultation rates. Arch Dis Child. 1991 May;66(5):633–635. doi: 10.1136/adc.66.5.633. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ferris B. G. Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis. 1978 Dec;118(6 Pt 2):1–120. [PubMed] [Google Scholar]
  7. Jenkins M. A., Clarke J. R., Carlin J. B., Robertson C. F., Hopper J. L., Dalton M. F., Holst D. P., Choi K., Giles G. G. Validation of questionnaire and bronchial hyperresponsiveness against respiratory physician assessment in the diagnosis of asthma. Int J Epidemiol. 1996 Jun;25(3):609–616. doi: 10.1093/ije/25.3.609. [DOI] [PubMed] [Google Scholar]
  8. Kaur B., Anderson H. R., Austin J., Burr M., Harkins L. S., Strachan D. P., Warner J. O. Prevalence of asthma symptoms, diagnosis, and treatment in 12-14 year old children across Great Britain (international study of asthma and allergies in childhood, ISAAC UK) BMJ. 1998 Jan 10;316(7125):118–124. doi: 10.1136/bmj.316.7125.118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lai C. K., Chan J. K., Chan A., Wong G., Ho A., Choy D., Lau J., Leung R. Comparison of the ISAAC video questionnaire (AVQ3.0) with the ISAAC written questionnaire for estimating asthma associated with bronchial hyperreactivity. Clin Exp Allergy. 1997 May;27(5):540–545. [PubMed] [Google Scholar]
  10. Pattemore P. K., Asher M. I., Harrison A. C., Mitchell E. A., Rea H. H., Stewart A. W. The interrelationship among bronchial hyperresponsiveness, the diagnosis of asthma, and asthma symptoms. Am Rev Respir Dis. 1990 Sep;142(3):549–554. doi: 10.1164/ajrccm/142.3.549. [DOI] [PubMed] [Google Scholar]
  11. Pedersen S. Early use of inhaled steroids in children with asthma. Clin Exp Allergy. 1997 Sep;27(9):995–1004. doi: 10.1111/j.1365-2222.1997.tb01247.x. [DOI] [PubMed] [Google Scholar]
  12. Pekkanen J., Pearce N. Defining asthma in epidemiological studies. Eur Respir J. 1999 Oct;14(4):951–957. doi: 10.1034/j.1399-3003.1999.14d37.x. [DOI] [PubMed] [Google Scholar]
  13. Sackett D. L. The rational clinical examination. A primer on the precision and accuracy of the clinical examination. JAMA. 1992 May 20;267(19):2638–2644. [PubMed] [Google Scholar]
  14. Sharma S. The likelihood ratio and ophthalmology: a review of how to critically appraise diagnostic studies. Can J Ophthalmol. 1997 Dec;32(7):475–478. [PubMed] [Google Scholar]
  15. Shaw R., Woodman K., Ayson M., Dibdin S., Winkelmann R., Crane J., Beasley R., Pearce N. Measuring the prevalence of bronchial hyper-responsiveness in children. Int J Epidemiol. 1995 Jun;24(3):597–602. doi: 10.1093/ije/24.3.597. [DOI] [PubMed] [Google Scholar]
  16. Siersted H. C., Boldsen J., Hansen H. S., Mostgaard G., Hyldebrandt N. Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study. BMJ. 1998 Feb 28;316(7132):651–656. [PMC free article] [PubMed] [Google Scholar]
  17. Simel D. L., Samsa G. P., Matchar D. B. Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol. 1991;44(8):763–770. doi: 10.1016/0895-4356(91)90128-v. [DOI] [PubMed] [Google Scholar]
  18. Sistek D., Tschopp J. M., Schindler C., Brutsche M., Ackermann-Liebrich U., Perruchoud A. P., Leuenberger P. Clinical diagnosis of current asthma: predictive value of respiratory symptoms in the SAPALDIA study. Swiss Study on Air Pollution and Lung Diseases in Adults. Eur Respir J. 2001 Feb;17(2):214–219. doi: 10.1183/09031936.01.17202140. [DOI] [PubMed] [Google Scholar]
  19. Wong T. W., Yu T. S., Wang X. R., Robinson P. Predicted maximal oxygen uptake in normal Hong Kong Chinese schoolchildren and those with respiratory diseases. Pediatr Pulmonol. 2001 Feb;31(2):126–132. doi: 10.1002/1099-0496(200102)31:2<126::aid-ppul1020>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  20. de Marco R., Cerveri I., Bugiani M., Ferrari M., Verlato G. An undetected burden of asthma in Italy: the relationship between clinical and epidemiological diagnosis of asthma. Eur Respir J. 1998 Mar;11(3):599–605. [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES