Yeatts Karin, Davis Kourtney Johnston, Sotir Mark, Herget Casey, Shy Carl
Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435, USA.
Pediatrics. 2003 May;111(5 Pt 1):1046-54. doi: 10.1542/peds.111.5.1046.
1). To describe the factors associated with not receiving an asthma diagnosis among children with frequent wheezing symptoms and 2). to determine risk factors for frequent wheezing in the population.
The North Carolina School Asthma Survey provided self-reported questionnaire data on respiratory health from 122 829 children ages 12 to 18 years enrolled in 499 public middle schools in North Carolina during the 1999-2000 school year. Questions from the International Survey of Allergies and Asthma in Childhood were used to estimate the prevalence of asthma and wheezing-related illness and associated factors.
Factors independently associated with undiagnosed frequent wheezing versus asymptomatic children included female gender (odds ratio [OR]: 1.45; 95% confidence interval [CI]: 1.35-1.54), current smoking (OR: 2.60; 95% CI: 2.43-2.79), exposure to household smoke (OR: 1.59; 95% CI: 1.50-1.70), low socioeconomic status (OR: 1.52; 95% CI: 1.42-1.63), and African American (OR: 1.25; 95% CI: 1.15-1.34), Native American (OR: 1.35; 95% CI: 1.11-1.62), and Mexican American (OR: 1.32; 95% CI: 1.17-1.48) race/ethnicity. Urban residence showed a weak negative association (OR: 0.91; 95% CI: 0.85-0.96). A similar pattern of results was observed for analyses comparing odds of undiagnosed frequent wheeze versus diagnosed asthmatics. Report of allergies was less likely in frequent wheezers (70%) compared with diagnosed asthmatics (86%), but much higher than in asymptomatic children (36%). Thirty-three percent of children with undiagnosed frequent wheezing reported 1 or more physician visits in the last year for wheezing or breathing problems compared with 71% of children with diagnosed asthma, and 4% in asymptomatic children. The prevalence of any inhaler use in the past 12 months was 12% for undiagnosed frequent wheezers versus 78% for diagnosed asthmatics. The proportion of undiagnosed frequent wheezers with fair or poor self-rated health (23%) was slightly higher than diagnosed asthmatics (20%) and much higher than asymptomatic children (4%).
In one of the largest adolescent asthma surveys ever reported in the United States, undiagnosed frequent wheezing was independently associated with female gender, current smoking, exposure to household smoke, low socioeconomic status, allergies, and African American, Native American, and Mexican American race/ethnicity. Children with undiagnosed frequent wheezing were not receiving adequate health care for their asthma-like illness. Clinicians who treat adolescents should consider asking adolescents specifically about wheezing. This information may assist primary care physicians in identifying children with undiagnosed asthma in need of treatment.
1）描述频繁出现喘息症状的儿童未得到哮喘诊断的相关因素；2）确定该人群中频繁喘息的风险因素。
北卡罗来纳州学校哮喘调查提供了1999 - 2000学年在北卡罗来纳州499所公立中学就读的122829名12至18岁儿童的自我报告的呼吸健康问卷数据。使用儿童期过敏和哮喘国际调查中的问题来估计哮喘和喘息相关疾病的患病率及相关因素。
与无症状儿童相比，未诊断出的频繁喘息儿童独立相关的因素包括女性（优势比[OR]：1.45；95%置信区间[CI]：1.35 - 1.54）、当前吸烟（OR：2.60；95% CI：2.43 - 2.79）、接触家庭烟雾（OR：1.59；95% CI：1.50 - 1.70）、社会经济地位低（OR：1.52；95% CI：1.42 - 1.63）以及非裔美国人（OR：1.25；95% CI：1.15 - 1.34）、美洲原住民（OR：1.35；95% CI：1.11 - 1.62）和墨西哥裔美国人（OR：1.32；95% CI：1.17 - 1.48）种族/族裔。城市居住呈现出较弱的负相关（OR：0.91；95% CI：0.85 - 0.96）。在比较未诊断出的频繁喘息与已诊断哮喘患者的优势比分析中观察到类似的结果模式。与已诊断哮喘患者（86%）相比，频繁喘息者（70%）报告过敏的可能性较小，但远高于无症状儿童（36%）。33%未诊断出的频繁喘息儿童在过去一年中因喘息或呼吸问题就诊1次或更多次，而已诊断哮喘的儿童为71%，无症状儿童为4%。在过去12个月中，未诊断出的频繁喘息者使用任何吸入器的患病率为12%，而已诊断哮喘患者为78%。自我健康评价为一般或较差的未诊断出的频繁喘息者比例（23%）略高于已诊断哮喘患者（20%），且远高于无症状儿童（4%）。
在美国有史以来最大规模的青少年哮喘调查之一中，未诊断出的频繁喘息与女性、当前吸烟、接触家庭烟雾、社会经济地位低、过敏以及非裔美国人、美洲原住民和墨西哥裔美国人种族/族裔独立相关。未诊断出的频繁喘息儿童的哮喘样疾病未得到充分的医疗护理。治疗青少年的临床医生应考虑专门询问青少年关于喘息的情况。这些信息可能有助于初级保健医生识别需要治疗的未诊断出哮喘的儿童。
