Diagnosis of asthma in children: the contribution of a detailed history and test results.

de Jong, Carmen C M; Pedersen, Eva S L; Mozún, Rebeca; Goutaki, Myrofora; Trachsel, Daniel; Barben, Juerg; Kuehni, Claudia E (2019). Diagnosis of asthma in children: the contribution of a detailed history and test results. European respiratory journal, 54(6), p. 1901326. European Respiratory Society 10.1183/13993003.01326-2019

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INTRODUCTION There are little data on the usefulness of different tests to diagnose asthma in children. AIM We assessed the contribution of a detailed history and a variety of diagnostic tests for diagnosing asthma in children. METHODS We studied children aged 6-16 years referred consecutively for evaluation of suspected asthma to two pulmonary outpatient clinics. Symptoms were assessed by parental questionnaire. The clinical evaluation included skin prick tests, measurement of fractional exhaled nitric oxide (FeNO), spirometry, bronchodilator reversibility and bronchial provocation tests (BPT) by exercise, methacholine, and mannitol. Asthma was diagnosed by the physicians at the end of the visit. We assessed diagnostic accuracy of symptoms and tests by calculating sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC). RESULTS Of the 111 participants, 80 (72%) were diagnosed with asthma. The combined sensitivity and specificity was highest for reported frequent wheeze (>3 attacks/year) (sensitivity 0.44-specificity 0.90), awakening due to wheeze (0.41-0.90), and wheeze triggered by pollen (0.46-0.83) or by pets (0.29-0.99). Of the diagnostic tests, the AUC was highest for FeNO measurement (0.80) and BPT by methacholine (0.81) or exercise (0.74), and lowest for FEV1 (0.62) and FEV1/FVC (0.66), assessed by spirometry. CONCLUSION This study suggests that specific questions about triggers and severity of wheeze, measurement of FeNO and BPT by methacholine or exercise contribute more to the diagnosis of asthma in school-aged children than spirometry, bronchodilator reversibility and skin prick tests.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)
Graduate School for Health Sciences (GHS)

UniBE Contributor:

de Jong, Carmen Cornelia Maria; Pedersen, Eva Sophie Lunde; Mozún Torrico, Rebeca; Goutaki, Myrofora and Kühni, Claudia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services
000 Computer science, knowledge & systems > 020 Library & information sciences

ISSN:

0903-1936

Publisher:

European Respiratory Society

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

19 Sep 2019 14:32

Last Modified:

13 Mar 2020 02:30

Publisher DOI:

10.1183/13993003.01326-2019

PubMed ID:

31515409

BORIS DOI:

10.7892/boris.133384

URI:

https://boris.unibe.ch/id/eprint/133384

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