Severe airway hyperresponsiveness was not predictable with the use of current tools in asthmatic children in general practice

• Published in: Journal of clinical epidemiology Vol. 60; no. 10; pp. 1052 - 1059
• Main Authors: Hagmolen of ten Have, W, van den Berg, N.J, van der Palen, J, van Aalderen, W.M.C, Bindels, P.J.E
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2007; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adrenergic beta-Agonists - administration & dosage; Allergies; Anti-Asthmatic Agents - administration & dosage; Asthma; Asthma - drug therapy; Asthma - physiopathology; Bias; Biological and medical sciences; Bronchial hyperreactivity; Bronchial Hyperreactivity - diagnosis; Bronchial Provocation Tests; Child; Children & youth; Chronic obstructive pulmonary disease, asthma; Confidence intervals; Cross-Sectional Studies; Drug Administration Schedule; Environmental information; Epidemiology; Family Practice; Female; General aspects; Glucocorticoids - administration & dosage; Humans; Inhalation; Internal Medicine; Male; Medical sciences; Methodology; Patient Selection; Peak Expiratory Flow Rate; Pneumology; Probability; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis; Risk Factors; Severity of Illness Index; Regression analysis; Family Practice; Child; Adolescent; Bronchial hyperreactivity; Asthma; Human; Lung disease; Hyperreactivity; Methodology; Respiratory disease; Use; Respiratory system; Epidemiology; Respiratory tract; Bronchus disease; General practice; Obstructive pulmonary disease; Severe; Tool use; Public health; Tool
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2007.01.013

Abstract Objective To evaluate whether moderate to severe airway hyperresponsiveness (AHR) could be suspected with the use of routinely available clinical and environmental information. Study Design and Setting Cross-sectional study of asthma in 526 asthmatics aged 7–17 years and treated in general practice. Results Moderate to severe AHR was present in 48% ( n = 253) of the participants. The presence of inhalation allergy, nocturnal symptoms, and usage of β2 -mimetics were significantly associated with moderate to severe AHR. If all three factors were present, the probability of the presence of moderate to severe and severe AHR was 76% and 36%, respectively. If all three were absent, the probability decreased to 11% and 5%, respectively. In 319 subjects (64%) AHR could not be adequately predicted with routinely available information. Conclusion Moderate and severe AHR could not be suspected with the use of routinely available clinical and environmental information in the majority of children. Except for a subgroup of children, our models were not helpful in deciding in which child an inhaled corticosteroid should be started or whether the dose should be increased or decreased. We recommend measuring the severity of AHR in these children by means of an inhalation challenge test.