Undiagnosed asthma in childhood

Abstract

Asthma is the most prevalent chronic disease in childhood. To study the actual prevalence and impact of undiagnosed childhood asthma in daily life (i.e. quality of life, participation in physical and school activities) we performed a survey in schoolchildren (aged 7-10 years) in the southern part of the Netherlands. Diagnosed asthma was defined as the parents’ confirmation of a physician’s diagnosis of asthma. Undiagnosed asthma was defined by asthma symptoms combined with airway reversibility or bronchial hyperresponsiveness (BHR). Our study shows that the majority of schoolchildren with asthma remain undiagnosed with a prevalence of 8%. The impact of undiagnosed asthma in daily life is substantial; i.e. children have a poorer lung function, lower quality of life scores and a higher school absence than their healthy peers. Furthermore, excessive bodyweight is associated with an additional decrease in quality of life in children with asthma. In addition our results show that children whose parents do not report a physician's diagnosis of asthma appear to perceive bronchoconstriction less well than children with diagnosed asthma. For a number of children this might be an explanation for a delay in asthma diagnosis. Childhood mild asthma - whether diagnosed or not - does not seem to be associated with a decreased level of daily physical activity compared with healthy controls. We found a high level of willingness among parents to visit their GP, as two thirds of our parents visited a physician after they had been informed that their child might suffer from asthma. Factors associated with refusal were high maternal education, mild symptoms and absence of airway reversibility. At the end of the program, medical treatment for asthma was started in two out of five children. High suspicion of undiagnosed asthma is warranted in school-age children with substantial school absence, respiratory symptoms or less specific symptoms (e.g. fatigue or sleeping problems).Children, caregivers, physicians and others involved in the daily life of children (e.g. teachers, sport trainers) can play an important role in recognizing asthma symptoms in the community. This might lead to important improvement of functioning and a decrease in the disability of schoolchildren.