Diana Silva1,2, Milton Severo3, Inês Paciência3,4, João Rufo3, Carla Martins1,2, Pedro Moreira5, Patrícia Padrão3,5, Luís Delgado1,2, André Moreira1,2,3. 1. Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal. 2. Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal. 3. EPI Unit - Instituto de Saúde Pública, University of Porto, Porto, Portugal. 4. Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal. 5. Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.
Abstract
BACKGROUND: The definitions of childhood asthma differ among epidemiological studies. We aimed to compare the diagnostic accuracy and agreement of previous asthma definitions and to evaluate questionnaire-driven asthma definition patterns. METHODS: Data on 808 participants aged 7-12 years from 20 schools were analyzed. Asthma definitions based on symptoms assessed by questionnaire, parent-reported medical asthma diagnosis, current use of asthma medication, airway reversibility after bronchodilatation, and increased (≥35 ppb) levels of exhaled nitric oxide (eNO) were compared with a gold standard (medical diagnosis of asthma with asthma symptoms in the past 12 months and/or airway reversibility). Concordance was assessed by Cohen's kappa. Data-driven analysis was applied to the questionnaire, and six scores were determined "asthma," "rhinitis," "cough," "non-specific respiratory symptoms," "treated asthma," and "uncontrolled asthma." Tree decisions were built using these scores. RESULTS: Definitions of asthma based on respiratory symptoms, airway reversibility, and parent-reported medical diagnosis had a low sensitivity but high specificity. Agreement between reported and objective measures was poor. Parent-reported medical asthma diagnosis, but not reversibility or eNO, was able to predict questionnaire-driven symptom patterns. Decision trees indicated that those with recent non-specific respiratory symptoms had a higher probability of positive bronchodilation. CONCLUSION: A standardized operational definition of asthma should include a composite score based on reported asthma medical diagnosis, symptoms, and lung function.
BACKGROUND: The definitions of childhood asthma differ among epidemiological studies. We aimed to compare the diagnostic accuracy and agreement of previous asthma definitions and to evaluate questionnaire-driven asthma definition patterns. METHODS: Data on 808 participants aged 7-12 years from 20 schools were analyzed. Asthma definitions based on symptoms assessed by questionnaire, parent-reported medical asthma diagnosis, current use of asthma medication, airway reversibility after bronchodilatation, and increased (≥35 ppb) levels of exhaled nitric oxide (eNO) were compared with a gold standard (medical diagnosis of asthma with asthma symptoms in the past 12 months and/or airway reversibility). Concordance was assessed by Cohen's kappa. Data-driven analysis was applied to the questionnaire, and six scores were determined "asthma," "rhinitis," "cough," "non-specific respiratory symptoms," "treated asthma," and "uncontrolled asthma." Tree decisions were built using these scores. RESULTS: Definitions of asthma based on respiratory symptoms, airway reversibility, and parent-reported medical diagnosis had a low sensitivity but high specificity. Agreement between reported and objective measures was poor. Parent-reported medical asthma diagnosis, but not reversibility or eNO, was able to predict questionnaire-driven symptom patterns. Decision trees indicated that those with recent non-specific respiratory symptoms had a higher probability of positive bronchodilation. CONCLUSION: A standardized operational definition of asthma should include a composite score based on reported asthma medical diagnosis, symptoms, and lung function.
Authors: Mohammad Shahidul Islam; Samin Huq; Steven Cunningham; Jurgen Schwarze; A S M D Ashraful Islam; Mashal Amin; Farrukh Raza; Radanath Satpathy; Pradipta Ranjan Rauta; Salahuddin Ahmed; Hana Mahmood; Genevie Fernandes; Benazir Baloch; Imran Nisar; Sajid Soofi; Pinaki Panigrahi; Sanjay Juvekar; Ashish Bavkedar; Abdullah H Baqui; Senjuti Saha; Harry Campbell; Aziz Sheikh; Harish Nair; Samir K Saha Journal: Ther Adv Infect Dis Date: 2022-07-18
Authors: Ruth J Geller; Janice A Espinola; Ronaldo C Fabiano Filho; Kohei Hasegawa; Jonathan M Mansbach; Ashley F Sullivan; Carlos A Camargo Journal: Ann Epidemiol Date: 2020-10-14 Impact factor: 3.797
Authors: Francisca de Castro-Mendes; Pedro Cunha; Inês Paciência; João Cavaleiro Rufo; Mariana Farraia; Diana Silva; Patrícia Padrão; Luís Delgado; André Moreira; Pedro Moreira Journal: Int J Environ Res Public Health Date: 2021-03-05 Impact factor: 3.390