Towards improving the accuracy of diagnosing asthma in early childhood.
OBJECTIVE
Early and correct diagnosis of asthma in wheezing children is essential for early treatment and prevention of under- or over-treatment. The aim was to study whether combining frequency and age of onset of wheezing illness with respiratory and atopic morbidity at age 0-6 years and sociodemographic parameters for asthma might be helpful for the general practitioner to diagnose asthma early and accurately.


METHODS
Birth cohort, mean follow-up 20 years (SD 4.8) in general practice. The outcome, adolescent asthma, was analysed in relation to wheezing and non-wheezing respiratory and personal and familial atopic morbidity. All diagnoses were from the Continuous Morbidity Registration of the Department of General Practice of the University of Nijmegen, the Netherlands.


RESULTS
1586 (64%) of the children could be followed. Adolescent asthma occurred in 6.4%. There were indications for under- and over-diagnosis of asthma at age 0-6 years. Non-recurrent wheezing (only one episode) and recurrent wheezing (>or =2 episodes) in the first three years of life, and recurrent wheezing at age 4-6 increased the risk with odds ratios (95% confidence interval) of 3.3 (1.9-5.6), 4.7 (2.8-8.2) and 15.4 (7.1-33.7), respectively. The risk additionally increased independently with a family history for asthma, (2.0 [1.1-3.6]), atopic dermatitis (1.7 [1.1-2.7]) and sinusitis (2.9 [1.3-6.4]) and decreased for > or =2nd born children (0.38 [0.19-0.47]) and those with a low social-economic status (0.61 [0.39-0.94]).


CONCLUSIONS
Easily available history and clinical data may facilitate the early diagnosis of asthma in children with wheezing illness.
Schönberger
Hubert
H
Department of General Practice, Caphri Research Institute, Maastricht, the Netherlands. huub.schonberger@hag.unimaas.nl
van Schayck
Onno
O
Muris
Jean
J
Bor
Hans
H
van den Hoogen
Henk
H
Knottnerus
André
A
van Weel
Chris
C
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000235:genetics; D001722:Birth Order; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000150:complications / Q000235:genetics; D005194:Family Practice; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012135:Respiratory Sounds; D012852:Sinusitis / Q000150:complications / Q000235:genetics; D012959:Socioeconomic Factors