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post in: News Date:08 Oct 2017, 15:35 views:828
Recurrent respiratory symptoms in children are extremely common. A proportion of those children who experience recurrent respiratory symptoms have asthmareversible airways natural obstruction associated with bronchial hyperreactivity, allergic inflammation of the treatment airways, and a response to treatment with bronchodilators and regular prophylactic inhaled anti-inflammatory agents. Since we cannot easily measure bronchial hyperresponsiveness or inflammation and clinical correlates are not specific, diagnosis often depends on response to treatment.
But how big is the proportion with asthma, how does that proportion vary with age, and are we successful in applying the asthma label and giving the asthma treatments to the right group of children? The prevalence of asthma has undoubtedly increased in industrialised countries over the last few decades. Increases in rates of physician diagnosis of asthma are partially accounted for by changes in diagnostic preference, but there is consistent survey evidence for the increasing prevalence of symptomatic wheezing.
Parent reported prevalence of attacks of wheezing in Oslo children aged 616 increased from.7.1994. 1, exercise induced bronchospasm is closely related to asthma, and the proportion of 12 year old children in Wales whose peak flow dropped by more than 25 after running doubled between 192, it was equally clear in the 1980s that childhood asthma was underdiagnosed and.
Eleven out of 31 Tyneside schoolchildren experiencing more than 12 episodes of wheezing per year and three out of 56 with 412 episodes per year had been offered a diagnosis of asthma by their general practitioner. 3, since then, growing awareness of the existence of childhood asthma and of the effectiveness and relative safety of regular inhaled prophylactic agents has led to considerably higher rates of diagnosis and treatment. Has the pendulum swung too far the other way?
Are we now making false diagnoses of asthma and subjecting a large number of children with self-limiting respiratory symptoms to unnecessary or unnecessarily prolonged drug treatment? Recent data on rates of diagnosis and treatment. The general practice records of 10 685 Tayside children aged 115 were carefully reviewed in 1991.
4, a history of persistent cough was documented in the records of 23 of children. Two or more episodes of wheeze were recorded in 11 of children, half of whom had received a diagnosis of asthma.
Treatment with anti-asthma therapy at any point in the past was found in 20 of records. Of the total population.4 had a formal diagnosis of asthma and.4 had received a prescription for asthma treatment in the previous three months (4.8 a bronchodilator,.2 an inhaled steroid, and 1 sodium cromoglycate). The authors of this study imply that their figures represent continuing underdiagnosis and undertreatment of asthma.
The recently published isaac study of asthma symptoms in 1214 year old British children was a school based questionnaire survey with an 86 response rate. 5, a 12 month prevalence of four or more attacks of wheeze.6 and of frequent night waking with wheeze.7 was reported.
A diagnosis of asthma had been given at some point in the past to 21 of children and 20 reported treatment with anti-asthma drugs in the previous year. Nevertheless, one third of the children reporting frequent nocturnal wheeze had no diagnosis of asthma and denied receiving inhaler therapy.
Four percent of the total sample continued to experience asthma symptoms with a moderate or greater interference with their lives despite having received diagnosis and treatment.