title: An increasing trend of the delay in asthma diagnosis after the discontinuation of a population-based intervention.
abstract: BACKGROUND
  We have previously analyzed the delay in asthma diagnosis in children from the cohort of Asthma Prevention Program in Lodz Province, Poland. That community-based intervention focused mainly on the improvement in access to specialists. The aim of this study was reevaluation of the timelines of all recent asthma diagnoses (N = 500) in children referred to our clinic after the discontinuation of the program, that is, in the time span from 2004 to 2009.
  
  
  METHODS
  Subjects with no previous diagnosis of asthma but a positive asthma predictive index were labeled as having undiagnosed asthma. The time from the first medical appointment when asthma could have been diagnosed the earliest until the final diagnosis of asthma was calculated for each subject and defined as the duration of undiagnosed asthma (years). All data were obtained from children's medical documentation and through phone interviews.
  
  
  RESULTS
  During the intervention program, the duration of undiagnosed asthma significantly decreased. However, it showed a significant upward trend after the discontinuation of the program. After 6 years since the program was abandoned, the average undiagnosed asthma duration returned to its initial length from before the intervention. The independent statistical predictors of the delayed asthma diagnosis were the absence of atopy and suboptimal initial antiasthma therapy.
  
  
  CONCLUSIONS
  Our results revealed the following: first, general practitioners do not follow the recommended guidelines for early detection of asthma in children; and second, a greater accessibility of specialists could enhance chances of early asthma diagnosis, especially in nonatopic children.
authors.affiliation: Department of Pediatrics and Allergy, N. Copernicus Hospital, Medical University of Lodz, Lodz, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Majak
authors.forename: Ewa
authors.initials: E
authors.lastname: Bąk-Walczak
authors.forename: Iwona
authors.initials: I
authors.lastname: Stelmach
authors.forename: Joanna
authors.initials: J
authors.lastname: Jerzyńska
authors.forename: Jan
authors.initials: J
authors.lastname: Krakowiak
authors.forename: Włodzimierz
authors.initials: W
authors.lastname: Stelmach
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001249:Asthma / Q000175:diagnosis*; D002648:Child; D057210:Delayed Diagnosis / Q000639:trends*; D058005:General Practitioners; D019983:Guideline Adherence; D006801:Humans; D016017:Odds Ratio; D011044:Poland; D017410:Practice Guidelines as Topic; D012307:Risk Factors