Green R, Luyt D
Children's Chest and Allergy Clinic, Johannesburg.
S Afr Med J. 1997 Jul;87(7):878-82.
To describe the clinical features of Caucasian childhood asthmatics in Johannesburg in order to compare these with a similar population of black asthmatic children resident in Soweto.
In a prospective study, a history was obtained by means of an investigator-administered questionnaire.
Presenting asthma symptoms, precipitants of symptoms, concomitant diagnoses, individual and family background of allergy and 'delay to diagnosis' of asthma (age at symptom onset subtracted from age at diagnosis) from history and allergen sensitivity as assessed by skin-prick tests (SPTs).
Of the 468 (297 boys) asthmatics studied, 456 (97.4%) presented with cough, 362 (77.3%) with wheeze, 286 (61.1%) with a tight chest and 277 (59.2%) with breathlessness. Cough as sole symptom occurred in 102 (21.8%) while only 8 (1.7%) wheezed and did not cough. Commonest symptom triggers were upper respiratory tract infections and activity/exercise. An individual atopic background was common-allergic rhinitis in 413 (88.2%)-as was a family history of atopy, present in 390 (83.3%). Prolonged symptomatic periods occurred in most patients before asthma was diagnosed (among children diagnosed after the age of 4 years, 50% had been symptomatic for more than 3 years). 'Delay to diagnosis' was not influenced by presenting symptoms or by previous hospitalisation for asthma. Other respiratory diagnoses of bronchitis and pneumonia were common, possibly because of misdiagnosis. Commonest allergens on SPT were corn pollen, Bermuda and 5-grass mix, and standardised mites. Aside from wheat, food allergy was uncommon.
Cough was the commonest presenting symptom despite its still being regarded as a less classic symptom of asthma that may account for misdiagnosis and a high frequency of other respiratory diagnoses. Associated allergy, especially allergic rhinitis, occurred frequently. Many aspects of presentation in whites were similar to those in Soweto children, although the latter had a more frequent concomitant diagnosis of tuberculosis, and recognised dust and cold weather as more frequent triggers. Differences might be influenced by the care-giving situation.
描述约翰内斯堡白人儿童哮喘患者的临床特征，以便与索韦托的类似黑人哮喘儿童群体进行比较。
在一项前瞻性研究中，通过研究者发放的问卷获取病史。
从病史中获取哮喘症状表现、症状诱发因素、伴随诊断、个人及家族过敏背景以及哮喘“诊断延迟”情况（诊断年龄减去症状出现年龄），并通过皮肤点刺试验（SPT）评估过敏原敏感性。
在研究的468例（297例男孩）哮喘患者中，456例（97.4%）有咳嗽症状，362例（77.3%）有喘息症状，286例（61.1%）有胸闷症状，277例（59.2%）有气促症状。仅以咳嗽为唯一症状的有102例（21.8%），而仅有8例（1.7%）有喘息但无咳嗽症状。最常见的症状诱发因素是上呼吸道感染和活动/运动。个体特应性背景常见——413例（88.2%）有过敏性鼻炎——家族特应性病史也常见，390例（83.3%）有。大多数患者在哮喘诊断前有较长症状期（4岁后诊断的儿童中，50%有症状超过3年）。“诊断延迟”不受症状表现或既往哮喘住院史影响。支气管炎和肺炎等其他呼吸道诊断常见，可能是由于误诊。SPT中最常见的过敏原是玉米花粉、百慕大草和5种混合草花粉以及标准化螨虫。除小麦外，食物过敏不常见。
尽管咳嗽仍被视为哮喘不太典型的症状，可能导致误诊及其他呼吸道诊断频率较高，但咳嗽仍是最常见的症状表现。相关过敏，尤其是过敏性鼻炎，很常见。白人患者的许多表现方面与索韦托儿童相似，尽管后者合并结核病诊断更频繁，且认为灰尘和寒冷天气是更常见的诱发因素。差异可能受护理情况影响。
