title: Multi-symptom asthma as an indication of disease severity in epidemiology.
abstract: Epidemiological questionnaires have failed to identify individuals with severe asthma. The extent of symptoms of asthma can, however, be easily established in epidemiology, by identification of multiple symptoms. We hypothesise that reporting of multiple symptoms of asthma reflects uncontrolled disease and is a sign of more severe asthma. The aims of the current study were, therefore, to determine the prevalence and determinants of multi-symptom asthma. A postal questionnaire was sent to 30,000 randomly selected individuals aged 16-75 yrs. A subgroup underwent clinical examinations. Multi-symptom asthma was defined as reported physician-diagnosed asthma, use of asthma medication, recurrent wheeze, attacks of shortness of breath and at least one additional respiratory symptom. The prevalence of multi-symptom asthma was 2.0%, and it was more common among females (2.4 versus 1.5%; p<0.001) and those with a body mass index >30 kg · m(-2). Multi-symptom asthmatics had lower forced expiratory volume in 1 s, higher exhaled nitric oxide fraction and more pronounced hyperresponsiveness. Family history of both asthma and allergy (OR 7.3), and occupational exposure to gas dust or fumes (OR 2.0) were also significant risk factors. Multi-symptom asthmatics comprise 2% of the general population; multi-symptom asthma is related to signs of more severe disease and could be used as an epidemiological marker of disease severity.
authors.affiliation: University of Gothenburg, Sahlgrenska Academy, Department of Internal Medicine/Krefting Research Centre, Box 424, SE-405 30 Gothenburg, Sweden. linda.ekerljung@gu.se
authors.forename: L
authors.initials: L
authors.lastname: Ekerljung
authors.forename: A
authors.initials: A
authors.lastname: Bossios
authors.forename: J
authors.initials: J
authors.lastname: Lötvall
authors.forename: A-C
authors.initials: AC
authors.lastname: Olin
authors.forename: E
authors.initials: E
authors.lastname: Rönmark
authors.forename: G
authors.initials: G
authors.lastname: Wennergren
authors.forename: K
authors.initials: K
authors.lastname: Torén
authors.forename: B
authors.initials: B
authors.lastname: Lundbäck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology*; D004417:Dyspnea / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011177:Postal Service; D015995:Prevalence; D012135:Respiratory Sounds; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents