Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren
Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren
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DOI：
10.1016/s0022-3476(96)70158-0
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发表时间：
1996-11-01
影响因子：
5.1
通讯作者：
Ownby, D
中科院分区：
文献类型：
--
作者：
Joseph, CLM;Foxman, B;Ownby, D
目的：城市儿童在没有医生诊断的情况下忍受哮喘症状和后果的程度还没有得到很好的研究。我们的目的是获得一个估计的患病率可能未确诊的哮喘在城市学龄儿童的人口。设计和方法：一个以人口为基础的横断面研究进行了城市学龄儿童，3至5年级。未确诊的哮喘被定义为看护报告的症状和/或支气管高反应性，定义为15%或更大的下降基线用力呼气量在1秒，运动challenge.Results：共有230名儿童（61%的合格）参加了这项研究。40名儿童（17.4%; 95%置信区间（CI）= 12.5%-22.3%）报告了医生诊断的哮喘。其中，33例（14.3%;（95% CI = 9.8%-18.9%））在过去12个月内报告了喘息。在其余189名合格儿童中，11名（5.8%; 95%CI = 2.5%-9.2%）符合基于支气管高反应性（BHR）的未诊断哮喘的研究标准。另外16例（8.5%; 95% CI = 4.5%-12.4%）符合通过改良的美国胸科学会症状标准确定的未诊断哮喘的研究标准。总体而言，27名儿童（27/189; 14.3%）符合未确诊哮喘的标准。将未确诊哮喘的儿童与没有BHR、没有症状和没有报告哮喘医生诊断的儿童（没有哮喘的儿童）进行比较。BHR儿童比无哮喘儿童更容易报告过敏和湿疹，比值比（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过敏，OR = 6.2（95% CI = 2.0 - 19.1），支气管炎，OR = 6.7（95% CI = 2.0至22.4），也更可能报告睡眠中断，OR = 7.1（95%CI = 2.3 ~ 21.8）和缺课的OR = 15.0（95%CI = 4.8 - 46.7），与无哮喘儿童相比。我们通过看护人报告症状或运动后BHR激发，估计3 - 5年级城市学龄儿童中可能未诊断的哮喘患病率为14.3%。未确诊哮喘的儿童比无哮喘的儿童更排斥特应性疾病。此外，符合哮喘症状标准的儿童比没有哮喘的儿童报告了更多的支气管炎，睡眠中断和错过体育课。这些结果表明，未确诊的哮喘率可能是高的，在这个主要是黑人学龄人口。
Objective: 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.Design and methods: 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.Results: 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.Conclusions: 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 repelted 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.