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


Abstract

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.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. de Jong has nothing to disclose.

Conflict of interest: Dr. Pedersen has nothing to disclose.

Conflict of interest: Dr. Mozun has nothing to disclose.

Conflict of interest: Dr. Goutaki has nothing to disclose.

Conflict of interest: Dr. Trachsel has nothing to disclose.

Conflict of interest: Dr. Barben has nothing to disclose.

Conflict of interest: Dr. Kuehni has nothing to disclose.

sumber : https://erj.ersjournals.com/content/early/2019/09/02/13993003.01326-2019?utm_source=TrendMD&utm_medium=cpc&utm_campaign=European_Respiratory_Journal_TrendMD_0

 
 

PRAKTEK Alamat 1:
RS Panti Waluya /RKZ Sawahan, Lt II-N
, Dr Koentjahja, SpP
Nusakambangan 56, Malang 65117
08113777488 / 362017 ext. 88.23
Pukul 17.45 - 19.45, hingga tgl 08 Januari 2020

Alamat 2:
RS Lavalette
, Dr Koentjahja, SpP
WR Supratman 10, Malang 65111
08133175788
Selasa & Kamis, Pukul 17.00 - 17.45, hingga tgl 08 Januari 2020

    
RUMAHWilis Indah A-6, Malang 65115
0341-568711


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