Diagnosis of asthma in children: findings from the Swiss Paediatric Airway Cohort.

de Jong, Carmen CM.; Pedersen, Eva SL.; Mozun, Rebeca; Müller-Suter, Dominik; Jochmann, Anja; Singer, Florian; Casaulta, Carmen; Regamey, Nicolas; Moeller, Alexander; Ardura-Garcia, Cristina; Kuehni, Claudia E (2020). Diagnosis of asthma in children: findings from the Swiss Paediatric Airway Cohort. European respiratory journal, 56(5), p. 2000132. European Respiratory Society 10.1183/13993003.00132-2020

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INTRODUCTION

Diagnosing asthma in children remains a challenge because respiratory symptoms are not specific and vary over time.

AIM

In a real-life observational study, we assessed the diagnostic accuracy of respiratory symptoms, objective tests, and two paediatric diagnostic algorithms proposed by GINA and NICE to diagnose asthma in school-aged children.

METHODS

We studied children aged 5-17 years referred consecutively for evaluation of suspected asthma to pulmonary outpatient clinics. Symptoms were assessed by parental questionnaire. The investigations included specific IgE measurement or skin prick tests, measurement of fractional exhaled nitric oxide, spirometry, body plethysmography, and bronchodilator reversibility. Asthma was diagnosed by paediatric pulmonologists based on all available data. We assessed diagnostic accuracy of symptoms, tests, and diagnostic algorithms by calculating sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC).

RESULTS

Among 514 participants, 357(70%) were diagnosed with asthma. The combined sensitivity and specificity (sensitivity/specificity) was highest for any wheeze (0.75/0.65), dyspnoea (0.56/0.76), and wheeze triggered by colds (0.58/0.78) or by exercise (0.55/0.74). Of the diagnostic tests, the AUC was highest for specific total resistance (sRtot) (0.73) and lowest for the residual volume (RV) total lung capacity (TLC) ratio (0.56). The NICE algorithm had a sensitivity of 0.69 and specificity of 0.67, whereas the GINA algorithm had a sensitivity of 0.42 and specificity of 0.90.

CONCLUSION

This study confirms the limited usefulness of single tests as well as existing algorithms for the diagnosis of asthma. It highlights the need for new and more appropriate evidence-based guidance.

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)
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Paediatric Pneumology

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; Mozun, Rebeca; Singer, Florian; Casaulta, Carmen; Ardura Garcia, Cristina and Kühni, Claudia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0903-1936

Publisher:

European Respiratory Society

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

10 Jun 2020 11:02

Last Modified:

06 Jan 2021 21:26

Publisher DOI:

10.1183/13993003.00132-2020

PubMed ID:

32499334

BORIS DOI:

10.7892/boris.144562

URI:

https://boris.unibe.ch/id/eprint/144562

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