PEDIATRICS Vol. 111 No. 5 May 2003, pp. 1046-1054
Who Gets Diagnosed With Asthma? Frequent Wheeze Among Adolescents With and Without a Diagnosis of Asthma
* Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, North Carolina
Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
--> Objective. 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.
Methods. 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.
Results. 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%).
Conclusions. 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.
Key Words: asthma • adolescents • wheezing • diagnosis • demographics • allergies
Abbreviations: ISAAC, International Survey of Asthma and Allergies in Childhood • NCSAS, North Carolina School Asthma Survey • OR, odds ratio • CI, confidence interval
Received for publication Jan 30, 2002; Accepted Sep 19, 2002.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  C K W Lai, R Beasley, J Crane, S Foliaki, J Shah, S Weiland, and the ISAAC Phase Three Study Group Global variation in the prevalence and severity of asthma symptoms: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) Thorax, June 1, 2009; 64(6): 476 - 483. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. G. P. Zuidgeest, L. van Dijk, P. Spreeuwenberg, H. A. Smit, B. Brunekreef, H. G. M. Arets, M. Bracke, and H. G. M. Leufkens What Drives Prescribing of Asthma Medication to Children? A Multilevel Population-Based Study Ann. Fam. Med, January 1, 2009; 7(1): 32 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. van Dalen, E. Harding, J. Parkin, S. Cheng, N. Pearce, and J. Douwes Suitability of Forced Expiratory Volume in 1 Second/Forced Vital Capacity vs Percentage of Predicted Forced Expiratory Volume in 1 Second for the Classification of Asthma Severity in Adolescents Arch Pediatr Adolesc Med, December 1, 2008; 162(12): 1169 - 1174. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. van Gent, L. E. M. van Essen-Zandvliet, M. M. Rovers, J. L. L. Kimpen, G. de Meer, and C. K. van der Ent Poor perception of dyspnoea in children with undiagnosed asthma Eur. Respir. J., November 1, 2007; 30(5): 887 - 891. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Singleton, R. C. Holman, N. Cobb, A. T. Curns, and E. L. Paisano Asthma Hospitalizations Among American Indian and Alaska Native People and for the General US Population. Chest, November 1, 2006; 130(5): 1554 - 1562. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Quinn, M. U. Shalowitz, C. A. Berry, T. Mijanovich, and R. L. Wolf Racial and Ethnic Disparities in Diagnosed and Possible Undiagnosed Asthma Among Public-School Children in Chicago Am J Public Health, September 1, 2006; 96(9): 1599 - 1603. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Mirabelli, S. Wing, S. W. Marshall, and T. C. Wilcosky Asthma Symptoms Among Adolescents Who Attend Public Schools That Are Located Near Confined Swine Feeding Operations Pediatrics, July 1, 2006; 118(1): e66 - e75. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Genuneit, G Weinmayr, K Radon, H Dressel, D Windstetter, P Rzehak, C Vogelberg, W Leupold, D Nowak, E von Mutius, et al. Smoking and the incidence of asthma during adolescence: results of a large cohort study in Germany Thorax, July 1, 2006; 61(7): 572 - 578. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Mandhane, J. M. Greene, J. O. Cowan, D. R. Taylor, and M. R. Sears Sex Differences in Factors Associated with Childhood- and Adolescent-Onset Wheeze Am. J. Respir. Crit. Care Med., July 1, 2005; 172(1): 45 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Akinbami, J. C. Rhodes, and M. Lara Racial and Ethnic Differences in Asthma Diagnosis Among Children Who Wheeze Pediatrics, May 1, 2005; 115(5): 1254 - 1260. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Borgmeyer, P. Jamerson, P. Gyr, N. Westhus, and E. Glynn The School Nurse Role in Asthma Management: Can the Action Plan Help? The Journal of School Nursing, February 1, 2005; 21(1): 23 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Elliott, K. Yeatts, and D. Loomis Ecological associations between asthma prevalence and potential exposure to farming Eur. Respir. J., December 1, 2004; 24(6): 938 - 941. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Yeatts, K. Johnston Davis, D. Peden, and C. Shy Health consequences associated with frequent wheezing in adolescents without asthma diagnosis Eur. Respir. J., November 1, 2003; 22(5): 781 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Identifying Adolescents with Asthma Journal Watch (General), May 13, 2003; 2003(513): 6 - 6. [Full Text]
|
|
