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Health Consequences for
Children With Undiagnosed Asthma-like Symptoms
Karin Yeatts, PhD; Carl Shy,
MD; Mark Sotir, MPH; Stan
Music, MD; Casey Herget, MSW, MPH
Arch Pediatr Adolesc Med. 2003;157:540-544.
Background A growing body of evidence
indicates that there are a substantial number
of children who report asthma-like symptoms
and are not diagnosed with asthma. However, there is
little information on the health consequences of
asthma-like symptoms for children with these
symptoms and no asthma diagnosis.
Objective To assess the prevalence and health
consequences (school absences, sleep
disturbances, activity limitations, physician
visits, emergency department visits, and
hospitalizations) of asthma-like symptoms
among children with and without physician
diagnosis.
Study Design We surveyed 122 829 children
aged 12 to 14 years in 499 North Carolina
public middle schools. A standardized
questionnaire (International Study of Asthma and
Allergies in Childhood [ISAAC]) containing
video scenes of adolescents experiencing
asthma-like symptoms was adapted to include questions on
health consequences.
Results Seventeen percent (n = 21 184)
reported current asthma-like symptoms with no
diagnosis of asthma (during the last 12
months.) Eleven percent (n = 13 619) of the children
reported physician-diagnosed asthma with current
asthma-like symptoms. Of the children with
asthma-like symptoms and no diagnosis of
asthma, 20% missed a half day or more of school per
month because of wheeze, 25% had limited
activities because of wheeze once or more per
month, and 32% had sleep disturbances because
of wheeze in the last 4 weeks. Seven percent of children
with current asthma-like symptoms but no
diagnosis reported 1 or more emergency
department visits for asthma-like symptoms, and
5% reported wheeze-related hospitalizations in the
last year. Of children with
physician-diagnosed asthma, almost half (47%)
reported missing a half day or more of school in the
last month. Thirty percent of
physician-diagnosed children reported 1 or
more emergency department visits in the last year for
asthma-like symptoms.
Conclusions The health consequences of
asthma-like symptoms in children with no
diagnosis are substantial; these children are
essentially untreated. Better detection of this disease
group by the medical community has the potential
to improve health consequences for these
children.
From the Department of Epidemiology, School of
Public Health, University of North Carolina at Chapel
Hill (Drs Yeatts and Shy and Mr Sotir); and Division of
Public Health, North Carolina Department of Health and
Human Services, Raleigh (Dr Music and Ms Herget). Dr
Music is now affiliated with Merck & Co, Inc, West
Point, Penn.
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