(Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study)
According to Siersted et al in this week's BMJ, one third of young people with asthma are not diagnosed, a phenomenon which is particularly prevalent in girls. In a Danish study of nearly 500 schoolchildren aged 12 -15 years, the authors found that asthma that had gone undiagnosed was usually linked to one or more of five factors.
A low level of physical activity is relatively unlikely to provoke the types of symptoms of asthma induced by exercise and so may form as part of a ëself-treatment' in childhood asthma. Low activity promotes weight gain, which in turn may lead to misinterpretation of asthma symptoms as due to lack of physical fitness.
Family problems may obscure a child's symptoms and parents who smoke may be disinclined to get a doctor's advice about symptoms related to smoke in the family. If a child has no history of allergic rhinitis then this can also lead to a diagnosis of asthma being overlooked.
Siersted et al conclude that as two thirds of those with undiagnosed asthma do not report their symptoms to a doctor, then there could be a good case for an asthma campaign targeting those families with children in the risk categories.
Dr Hans Siersted, Senior Registrar, Section of Respiratory Diseases, Department of Medicine C, Odense Hospital, DK-5000 Odense C, Denmark firstname.lastname@example.org
The Siersted paper is accompanied by three commentaries:-
(Commentary: Risk factors for underdiagnosis of asthma in adolescence)
John Rees, Consultant Physician, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, London
(Commentary: Identifying the correct risks in diagnosis)
Stephen Evans, Visiting Professor of Medical Statistics, London School of Hygiene and Tropical Medicine, London
(Commentary: Improving the diagnostic rate in asthma: a community issue)
Hans Siersted, As above.