Defining asthma in epidemiological studies

Pekkanen, Juha; Pearce, Neil

doi:10.1034/j.1399-3003.1999.14d37.x

Cited by 243 publications

(197 citation statements)

References 42 publications

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“…Self-reported asthma or physician-diagnosed asthma has a high specificity and a low sensitivity [1,2]. Regarding asthma, the gold standard can be a problematic issue, but mostly the gold standard for asthma has been either clinical investigations, including metacholine challenge tests or a clinical investigation performed by a physician.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnostic criteria for new-onset asthma have been based on either clinical investigations, or self-reported asthma or physician-diagnosed asthma [1,2]. Reports on asthma are more common and, over the last 10 yrs, questionnaire-based incidence studies have been published in the USA, Scandinavia, Spain and Italy, showing incidence rates from 1-5 cases per 1,000 person-yrs -1 [3][4][5][6][7][8][9].…”

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confidence: 99%

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A prospective study of asthma incidence and its predictors: the RHINE study

Torén,

Gislason,

Omenaas

et al. 2004

Eur Respir J

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The objective of this longitudinal study was to estimate the incidence rate of asthma, and to compare the incidence between subjects with or without baseline reporting of certain respiratory symptoms.A follow-up of the random population samples in the European Respiratory Health Survey (ECRHS) in Sweden, Norway, Denmark, Iceland and Estonia was conducted in 1999-2001, in a population aged 30-54 yrs at follow-up (n=14,731). Asthma was defined as reporting either asthma or physician-diagnosed asthma, and a reported year when asthma symptoms were first noticed. Incidence rates, incidence rate ratios and hazard ratios were calculated with 95% confidence intervals.The incidence rate of asthma was 2.2 cases per 1,000 person-yrs. The incidence was higher among females (2.9 cases?1,000 person-yrs -1 ) than among males (1.5 cases?1,000 person-yrs -1 ). When subjects with baseline reporting of wheezing were excluded, the incidence rate decreased to 1.7 cases?1,000 person-yrs -1 , with a further decrease to 1.5 cases?1,000 person-yrs -1 after exclusion of subjects with wheezing, nocturnal dyspnoea, chest tightness and cough. There was a strong association between onset of asthma and wheezing at baseline.In this prospective, population-based study, the incidence rate of asthma in the whole population sample ranged 1.5-2.2?1,000 person-yrs -1 , with a higher incidence range among females. The incidence was dependent on the extent to which subjects with respiratory symptoms were excluded from follow-up. Hence, for comparability between studies, the exclusion criteria in the follow-up population must be stated. Eur Respir J 2004; 24: 942-946.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A prospective study of asthma incidence and its predictors: the RHINE study

Torén,

Gislason,

Omenaas

et al. 2004

Eur Respir J

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“…Specificity and negative predictive value were, however, elevated. 33 In general, the accuracy of a measure is tested against a gold standard. In the absence of such, clinical history is sufficient for an epidemiological diagnosis of asthma.…”

Section: Discussionmentioning

confidence: 99%

“…In the absence of such, clinical history is sufficient for an epidemiological diagnosis of asthma. 33 Nevertheless, this review only covered studies in the English, German, Danish and Italian languages. This being the case, their conclusions are not applicable to Portuguese-speaking countries.…”

Section: Discussionmentioning

confidence: 99%

Asma em escolares do Recife - comparação de prevalências: 1994-95 e 2002

Britto

Bezerra

Brito

et al. 2004

J. Pediatr. (Rio J.)

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Objectives: To describe the prevalence of asthma and asthma variants in schoolchildren from Recife in 2002, and to compare these data with data from ; to analyze the relationship between maternal schooling and the presence of asthma or worsening asthma; and to evaluate the diagnostic accuracy of the yearly prevalence of wheezing as an asthma indicator.Methods: Cross-sectional study. A probabilistic sample of 3,086 and 2,774 13-and 14-year-old students answered a written questionnaire in 1994-95 and 2002, as part of the International Study of Asthma and Allergies in Childhood.Results: The following prevalence rates were observed in 1994-95 and 2002, respectively: cumulative prevalence of referred asthma: 21 vs 18.2%; cumulative prevalence of wheezing: 39 vs 38%; yearly prevalence of wheezing: 19.7 vs 19.4%; yearly prevalence of night cough: 31 vs 38%; yearly prevalence of exercise-induced wheezing: 20.6 vs 23.8%. The yearly prevalence of asthma attacks was 16.3 vs 15.2% for 1 to 3 attacks; 2.7 vs 1.2% for 4 to 12 attacks; and 1 vs 0.4% for more than 12 attacks. The yearly prevalence of attacks that disturbed sleep was 13 and 10.3%. The yearly prevalence of attacks with compromised speech was 4.8 and 4.1%. Higher levels of maternal schooling were related to higher cumulative prevalence of referred asthma and to cumulative and yearly prevalence of wheezing. Conclusions:The prevalence of asthma and its severe forms is high in teenager students in Recife. It is also related to higher levels of maternal schooling. IntroductionAsthma is a chronic inflammatory disease of the airways, predominantly eosinophilic, which results in a recurrent obstruction of the airflow, reversible spontaneously or in response to therapy. Atopic disease is the most frequently identified predisposing factor. 1-4 It constitutes a public health problem, as much for its prevalence as for its morbidity. [5][6][7][8][9] During phase one of ISAAC, (International Study of Asthma and Allergies in Childhood), 463,801 13 and 14 year-old adolescents and 257,800 children aged 6 and 7 years of age, from 56 countries were studied by questionnaire. The average cumulative prevalence of asthma reported was 11.3%, varying from 1.4 to 30.4%. Brazil was eighth in the ranking. 5 This project investigated 20,544 schoolchildren aged 13-14 years and 13,604 aged 6-7 years, in Curitiba, Itabira, Recife, Salvador, São Paulo, Porto Alegre and Uberlândia. In the first group, the reported prevalence of asthma was 9.8% for males and 10.2% for females. In the 6-7 year-old group, it was 7.3 and 4.9%, respectively. 6 In Recife, the ISAAC data from 1994-95 for 1,410 schoolchildren aged 6 and 7 years and 3,086 pupils aged 13 and 14 years old, demonstrated a reported asthma prevalence of 20.4 and 19.7%, respectively. 7 Further Brazilian studies using methods similar to those of the ISAAC project have also been performed recently. In schoolchildren from Uberlândia aged 6 and 7 In addition to the point-by-point assessments, the comparison of different periods allows ...

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“…The tested symptoms were obtained from repeated qualitative surveys on patients admitted to an asthma-allergy clinic. Epidemiological studies have also shown that there is no quite typical symptom of asthma, but wheeze or the combination of wheeze and other symptoms seems to be the best available choice (29)(30)(31)(32).…”

Section: Asthma Symptomsmentioning

confidence: 99%

Diagnosis of asthma – a new approach

Löwhagen

2012

Allergy

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Current definition of asthma involves four cornerstones: inflammation, hyperresponsiveness, bronchoconstriction, and symptoms. In research, the symptoms have had the slightest attention. According to international guidelines, the asthma symptoms are episodic breathlessness, wheeze, cough, tightness of the chest, and shortness of breath. As there are several symptoms, a primary question is how they are related to bronchoconstriction, the main clinical feature of asthma. Symptoms and lung function tests are regularly used for the evaluation of clinical health status and effect of treatment. However, there is no or poor correlation between these two variables, which means that they represent different mechanisms. Reduced lung function, such as a low FEV 1 , represents bronchial constriction, what do the symptoms represent? Some symptoms such as breathlessness and shortness of breath seem not to be evidence-based asthma symptoms. Focusing on bronchial obstruction is important in view of the potential risk of asthma attacks, but nonobstructive symptoms occur frequently and may also cause severe discomfort and poor quality of life. Interpreting all symptoms as signs of bronchoconstriction (asthma) may lead to misinterpretation when assessing health status and effect of treatment. Although a 'soft' variable, the strength of symptoms is that they are representing various mechanisms. The physiological preconditions for control and defense of respiration must be considered in the diagnostic process, regardless of inflammation, allergy, psychology, or other etiological factors. Based on studies on dyspnea in cardiopulmonary diseases, including asthma and asthma-like disorders, there seems to be a continuous spectrum of symptoms and mechanisms integrated in a single asthma syndrome.

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Defining asthma in epidemiological studies

Cited by 243 publications

References 42 publications

A prospective study of asthma incidence and its predictors: the RHINE study

A prospective study of asthma incidence and its predictors: the RHINE study

Asma em escolares do Recife - comparação de prevalências: 1994-95 e 2002

Diagnosis of asthma – a new approach

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