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

Carmen C.M. de Jong, Eva S.L. Pedersen, Rebeca Mozun, Myrofora Goutaki, Daniel Trachsel, Juerg Barben, Claudia E. Kuehni
European Respiratory Journal 2019 54: 1901326; DOI: 10.1183/13993003.01326-2019
Carmen C.M. de Jong
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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  • ORCID record for Carmen C.M. de Jong
Eva S.L. Pedersen
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Rebeca Mozun
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Myrofora Goutaki
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
2Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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Daniel Trachsel
3Paediatric Respiratory Medicine, Children's University Hospital of Basel, Basel, Switzerland
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Juerg Barben
4Paediatric Respiratory Medicine, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
5These authors contributed equally
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Claudia E. Kuehni
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
2Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
5These authors contributed equally
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  • ORCID record for Claudia E. Kuehni
  • For correspondence: claudia.kuehni@ispm.unibe.ch
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Abstract

Introduction There are few 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 exhaled nitric oxide fraction (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 (more than three attacks per 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 forced expiratory volume in 1 s (FEV1) (0.62) and FEV1/forced vital capacity ratio (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.

Abstract

Diagnosing asthma in children is most accurately done by using information on triggers and severity of wheeze and by FeNO measurement, methacholine and exercise challenge tests. http://bit.ly/2kDWaRr

Footnotes

  • This article has supplementary material available from erj.ersjournals.com.

  • Author contributions: C.E. Kuehni and J. Barben conceptualised and designed the study. D. Trachsel and J. Barben supervised data collection. C.C.M. de Jong analysed the data and drafted the manuscript. E.S.L. Pedersen and M. Goutaki supported the statistical analysis and gave input for interpretation of the data. All authors critically revised the manuscript and approved the final manuscript as submitted.

  • Conflict of interest: C.C.M. de Jong has nothing to disclose.

  • Conflict of interest: E.S.L. Pedersen has nothing to disclose.

  • Conflict of interest: R. Mozun has nothing to disclose.

  • Conflict of interest: M. Goutaki has nothing to disclose.

  • Conflict of interest: D. Trachsel has nothing to disclose.

  • Conflict of interest: J. Barben has nothing to disclose.

  • Conflict of interest: C.E. Kuehni has nothing to disclose.

  • Support statement: This work was supported by the Swiss National Science Foundation (grant 32003B_162820), AstraZeneca (Switzerland), the Lung League St Gallen and the Schmidheiny Foundation (Heerbrugg, St Gallen). Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received July 5, 2019.
  • Accepted September 3, 2019.
  • Copyright ©ERS 2019
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Diagnosis of asthma in children: the contribution of a detailed history and test results
Carmen C.M. de Jong, Eva S.L. Pedersen, Rebeca Mozun, Myrofora Goutaki, Daniel Trachsel, Juerg Barben, Claudia E. Kuehni
European Respiratory Journal Dec 2019, 54 (6) 1901326; DOI: 10.1183/13993003.01326-2019

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