BACKGROUND: The theory that airway remodeling and possible fixed asthma may result from failure to treat asthma airway inflammation highlights the importance of the early identification of patients with likely asthma. AIM: To identify children with likely asthma whose condition is unknown to the medical services. STUDY: Postal questionnaire survey. SETTING: Children in two general practice populations in 1999. METHOD: Parents completed the postal questionnaire surveys. Two validated scoring systems were used to identify children with 'likely asthma': first, three or more positive responses to five key questions; second, three or more positive responses to the same five questions and one more severe symptom (e.g. exercise-induced wheeze). Questionnaire responses were linked to practice records to determine those with a recorded diagnosis of asthma (ever) or of inhaled medication (past 12 months). RESULTS: Using the first scoring system, 22.5% of children were identified as having likely asthma; more than one-third of these (35.1%) had no corroborative evidence recorded in the practice records. With the second system, 15.5% had likely asthma, a quarter of whom had no corroborative evidence. Depending on the scoring system chosen, between 3.5% and 8% of children in these practices had likely asthma but no corroborative evidence in their records. CONCLUSIONS: Children identified using either of these scoring systems would require full clinical assessment to determine their need for medical intervention. These findings have implications for the allocation of health care resources.
BACKGROUND: The theory that airway remodeling and possible fixed asthma may result from failure to treat asthma airway inflammation highlights the importance of the early identification of patients with likely asthma. AIM: To identify children with likely asthma whose condition is unknown to the medical services. STUDY: Postal questionnaire survey. SETTING:Children in two general practice populations in 1999. METHOD: Parents completed the postal questionnaire surveys. Two validated scoring systems were used to identify children with 'likely asthma': first, three or more positive responses to five key questions; second, three or more positive responses to the same five questions and one more severe symptom (e.g. exercise-induced wheeze). Questionnaire responses were linked to practice records to determine those with a recorded diagnosis of asthma (ever) or of inhaled medication (past 12 months). RESULTS: Using the first scoring system, 22.5% of children were identified as having likely asthma; more than one-third of these (35.1%) had no corroborative evidence recorded in the practice records. With the second system, 15.5% had likely asthma, a quarter of whom had no corroborative evidence. Depending on the scoring system chosen, between 3.5% and 8% of children in these practices had likely asthma but no corroborative evidence in their records. CONCLUSIONS:Children identified using either of these scoring systems would require full clinical assessment to determine their need for medical intervention. These findings have implications for the allocation of health care resources.
Authors: Peter I Frank; Paul D Wicks; Michelle L Hazell; Mary F Linehan; Sybil Hirsch; Philip C Hannaford; Timothy L Frank Journal: Br J Gen Pract Date: 2005-08 Impact factor: 5.386