The developmental trajectory of pediatric asthma in 3- to-10-year-olds

• Published in: Journal of allergy and clinical immunology Vol. 129; no. 5; pp. 1397 - 1398
• Main Authors: Wu, Pingsheng, PhD, Carroll, Kecia N., MD, MPH, Gebretsadik, Tebeb, MPH, Dupont, William D., PhD, Mitchel, Edward F., MS, Hartert, Tina V., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2012; Elsevier Limited
• Subjects: Age; Age of Onset; Algorithms; Allergy and Immunology; Asthma; Asthma - diagnosis; Asthma - epidemiology; Asthma - physiopathology; Child; Child, Preschool; Cohort Studies; Disease; Disease Progression; Electronic Health Records - statistics & numerical data; Ethnic Groups; Ethnicity; Female; Follow-Up Studies; Gender; Humans; Male; Males; Medicaid; Predictive Value of Tests; Prevalence; Recurrence; Remittances; Sensitivity and Specificity; Sex Factors; Tennessee; Tennessee
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2012.01.029

Asthma was diagnosed in the parent cohort from which these data are derived, during age 3.5 to 5.5 years by using an established modified Healthcare Effectiveness Data and Information Set algorithm incorporating diagnostic coding and asthma-specific medication use.4,5 Children with an International Classification of Diseases, 9th Revision, Clinical Modification diagnosis code of 493 (asthma) or children with asthma-specific prescription use in a 365-day period were considered to have asthma as has been previously described in greater detail.6-8 Our asthma definition had been validated as both sensitive and specific.6 In addition, our algorithm used to diagnose childhood asthma is similar to that used by other US Medicaid systems, a modified algorithm of the Council of State and Territorial Epidemiologists, which has been shown to have 90% sensitivity, 95% specificity, 94% positive predictive value, and 92% negative predictive value in identifying childhood asthma.9 In addition, we excluded children with diagnoses of chronic diseases including chronic lung, heart, airway, immunodeficiency, or neurologic disease.4,6-7 We further defined asthma period prevalence in 2-year blocks between ages 7 to 8 years (from the 6th to the 8th birthday) and between ages 9 to 10 years (from the 8th to the 10th birthday) using the same criteria. Studies relying on an asthma diagnosis at a single age or age range would miss children who develop disease later during childhood, or have disease remittance. Because we define children as having asthma using both physician diagnosis and medication use, misclassification from physicians' reluctance to label/code a child with asthma, particularly at younger ages, should be minimized.