Childhood asthma: reasons for diagnostic delay and facilitation of early diagnosis--a qualitative study.
BACKGROUND
Children with undiagnosed asthmatic symptoms account for much illness and hospitalisation. The aim of the study was to identify reasons for diagnostic delay in childhood asthma and to develop tools for early diagnosis.


METHODS
A qualitative study, using semi-structured interviews with the parents of 30 children with asthma aged 2-15 years, combined with 15 GP interviews.


RESULTS
Asthma symptoms for most of the children started during their first year. The typical symptom pattern reported by parents consisted of insidious recurrent or continuous respiratory symptoms, particularly bad at night, often lasting several weeks or months, provoked or aggravated by common colds or foggy weather. In describing the symptoms, parents focussed on coughing and sputum production. As in other studies, the children's asthmatic diagnosis was obscured by excessive diagnostic emphasis on respiratory infections. The reasons for diagnostic delay seemed to be, typically, that doctors did not pay enough attention to the history of recurrent cough and unspecified respiratory symptoms, just as the parents' use of lay and onomatopoeic terms and metaphors for wheezing seemed to be misinterpreted. Furthermore some doctors relied more on the present symptoms and physical examination, although asthmatic patients may have normal auscultation on examination. Several doctors did not expect asthma in infancy.


CONCLUSIONS
The underlying reason for diagnostic delay could be that a former diagnostic definition of asthma, focussing on severe and dramatic cases, was still used by doctors. However, adapting to a new diagnostic concept for asthma, which highlights a history of periodic or chronic cough, wheeze and/or breathing difficulties and the typical asthma pattern in toddlers as shown in this study, may enable earlier diagnosis and treatment.
Østergaard
Marianne Stubbe
MS
Department of General Practice, Panum, University of Copenhagen, Blegdamsvej 3, DK 2200 N, Denmark. m.stubbe@gpmed.ku.dk