Joseph C L, Foxman B, Leickly F E, Peterson E, Ownby D
Henry Ford Health System, Detroit, Michigan, USA.
J Pediatr. 1996 Nov;129(5):735-42. doi: 10.1016/s0022-3476(96)70158-0.
The extent to which urban children endure the symptoms and consequences of asthma without a physician diagnosis has not been well studied. Our objective was to obtain an estimate of the prevalence of possible undiagnosed asthma in a population of urban schoolchildren.
A population-based cross-sectional study was conducted in urban schoolchildren, grades 3 to 5. Undiagnosed asthma was defined as caretaker report of symptoms and/or bronchial hyperresponsiveness, defined as a 15% or greater drop in baseline forced expiratory volume in 1 second, after exercise challenge.
A total of 230 children (61% of those eligible) participated in the study. Forty children (17.4%; 95% Confidence interval (CI) = 12.5% to 22.3%) had reports of a physician diagnosis of asthma. Of these, 33 (14.3%; (95% CI = 9.8% to 18.9%) reported wheezing in the past 12 months. Among the remaining 189 eligible children, 11 (5.8%; 95% CI = 2.5% to 9.2%) met study criteria for undiagnosed asthma based on bronchial hyperresponsiveness (BHR). Another 16 (8.5%; 95% CI = 4.5% to 12.4%) met study criteria for undiagnosed asthma through modified American Thoracic Society symptom criteria. Overall, 27 children (27/189; 14.3%) fulfilled criteria for undiagnosed asthma. Children identified as having undiagnosed asthma were compared with children who had no BHR and no symptoms and who did not report a physician diagnosis of asthma (children without asthma). Children with BHR were more likely to have a report of allergies and eczema than children without asthma, odds ratios (OR) = 8.5 (95% CI = 2.4 to 30.7) and 6.4 (95% CI = 1.1 to 38.1), respectively. Children meeting symptom criteria were more likely to have a report of allergies, OR = 6.2 (95% CI = 2.0 to 19.1), and bronchitis, OR = 6.7 (95% CI = 2.0 to 22.4), and were also more likely to report sleep disruption, OR = 7.1 (95% CI = 2.3 to 21.8) and missed physical education classes, OR = 15.0 (95% CI = 4.8 to 46.7), compared with children without asthma.
We estimated a prevalence of 14.3% for possible undiagnosed asthma among urban schoolchildren, grades 3 to 5, through caretaker report of symptoms or BHR postexercise challenge. Children with undiagnosed asthma reported more atopic disease than children without asthma. In addition, children meeting symptom criteria for asthma reported more bronchitis, sleep disruption, and missed physical education classes than did those without asthma. These results suggest that rates of undiagnosed asthma may be high in this predominantly black school-age population.
城市儿童在未经医生诊断的情况下忍受哮喘症状及后果的程度尚未得到充分研究。我们的目的是估计城市学龄儿童中可能未被诊断出的哮喘患病率。
对三至五年级的城市学龄儿童进行了一项基于人群的横断面研究。未被诊断出的哮喘定义为照顾者报告的症状和/或支气管高反应性，支气管高反应性定义为运动激发后第一秒用力呼气量较基线下降15%或更多。
共有230名儿童（占符合条件者的61%）参与了研究。40名儿童（17.4%；95%置信区间（CI）=12.5%至22.3%）有医生诊断哮喘的报告。其中，33名（14.3%；95%CI=9.8%至18.9%）报告在过去12个月中有喘息。在其余189名符合条件的儿童中，11名（5.8%；95%CI=2.5%至9.2%）基于支气管高反应性（BHR）符合未被诊断出的哮喘研究标准。另有16名（8.5%；95%CI=4.5%至12.4%）通过修改后的美国胸科学会症状标准符合未被诊断出的哮喘研究标准。总体而言，27名儿童（27/189；14.3%）符合未被诊断出的哮喘标准。将被确定为有未被诊断出的哮喘的儿童与没有BHR、没有症状且未报告医生诊断哮喘的儿童（无哮喘儿童）进行比较。与无哮喘儿童相比，有BHR的儿童更有可能报告有过敏和湿疹，优势比（OR）分别为8.5（95%CI=2.4至30.7）和6.4（95%CI=1.1至38.1）。符合症状标准的儿童更有可能报告有过敏，OR=6.2（95%CI=2.0至19.1），以及支气管炎，OR=6.7（95%CI=2.0至22.4），并且与无哮喘儿童相比，也更有可能报告睡眠中断，OR=7.1（95%CI=2.3至21.8）和体育课缺课，OR=15.0（95%CI=4.8至46.7）。
通过照顾者报告症状或运动激发后的BHR，我们估计三至五年级城市学龄儿童中可能未被诊断出的哮喘患病率为14.3%。与无哮喘儿童相比，有未被诊断出的哮喘的儿童报告的特应性疾病更多。此外，符合哮喘症状标准的儿童比无哮喘儿童报告的支气管炎、睡眠中断和体育课缺课更多。这些结果表明，在这个以黑人为主的学龄人群中，未被诊断出的哮喘发生率可能很高。
