Epidemiological diagnosis of asthma: Methodological considerations of prevalence evaluation

Cerveri, Isa; Bruschi, C.; Ricciardi, M. L.; Zocchi, Luciano; Zoia, M. C.; Rampulla, C

doi:10.1007/bf00239760

Cited by 20 publications

(14 citation statements)

References 8 publications

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“…Our findings concur with other literature that suggests that questionnaire asthma diagnosis is specific but not sensitive for asthma[14-17]. As expected, compared with questionnaires that use a definition of "wheezing in the last twelve months" to define the population with asthma, our definition of physician diagnosed asthma was more specific but less sensitive[18].…”

Section: Discussionsupporting

confidence: 90%

Verifying a questionnaire diagnosis of asthma in children using health claims data

Yang

Foty

et al. 2011

BMC Pulm Med

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BackgroundChildhood asthma prevalence is widely measured by parental proxy report of physician-diagnosed asthma in questionnaires. Our objective was to validate this measure in a North American population.MethodsThe 2884 study participants were a subsample of 5619 school children aged 5 to 9 years from 231 schools participating in the Toronto Child Health Evaluation Questionnaire study in 2006. We compared agreement between "questionnaire diagnosis" and a previously validated "health claims data diagnosis". Sensitivity, specificity and kappa were calculated for the questionnaire diagnosis using the health claims diagnosis as the reference standard.ResultsPrevalence of asthma was 15.7% by questionnaire and 21.4% by health claims data. Questionnaire diagnosis was insensitive (59.0%) but specific (95.9%) for asthma. When children with asthma-related symptoms were excluded, the sensitivity increased (83.6%), and specificity remained high (93.6%).ConclusionsOur results show that parental report of asthma by questionnaire has low sensitivity but high specificity as an asthma prevalence measure. In addition, children with "asthma-related symptoms" may represent a large fraction of under-diagnosed asthma and they should be excluded from the inception cohort for risk factor studies.

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Section: Discussionsupporting

confidence: 90%

Verifying a questionnaire diagnosis of asthma in children using health claims data

Yang

Foty

et al. 2011

BMC Pulm Med

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“…This is partly due to the case mix in the clinical studies [44], as BHR does not fare so well in a general population survey that includes many mild or borderline asthmatics, and in which many of the nonasthmatics have atopy, a family history of asthma or respiratory diagnoses other than asthma [51]. In addition, clinical studies as well as several population‐based studies [7, 32, 34, 41–43] have not adjusted for the sampling method used in their analyses and therefore the reported sensitivities and specificities may not be representative of the original source population [44].…”

Section: Discussionmentioning

confidence: 99%

“…Several population‐based studies [7, 32, 34, 41–43] did not adjust their analyses for the sampling method used; thus, the reported sensitivities and specificities may not apply to the original source population [44]. Therefore, those studies in which results adjusted for sampling could not be calculated from the published figures were excluded.…”

Section: Comparative Validity Of Symptom Questionnaires and Bronchialmentioning

confidence: 99%

Defining asthma in epidemiological studies

Pekkanen¹,

1999

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It has been suggested that, in epidemiological studies, asthma should be defined as symptomatic bronchial hyperresponsiveness (BHR). This paper critically examines the validity of this and alternative methods of defining asthma by reviewing population-based studies validating BHR and symptom questionnaires against asthma defined on the basis of a clinical assessment. It is emphasized that a single definition of asthma will not be applicable to all studies.When the aim of a study is to compare differences in prevalence of asthma between populations, Youden's Index (sensitivity + specificity -1) is the best single measure of validity. BHR has similar or better specificity, but much worse sensitivity, and therefore a worse Youden's Index, than symptom questionnaires. When the aim is to estimate relative risks, the validity of the definition of asthma depends more on its positive predictive value. Therefore, more specific methods of detecting asthmatics, such as severe symptoms, diagnoses of asthma, or symptomatic BHR may be most useful in cohort and case-control studies. In contrast, conversely, the method of choice for the first phase of prevalence comparisons is standardized written or video symptom questionnaires.In order to explore reasons for the differences in asthma prevalence, and to estimate possible differential symptom reporting, questionnaires can be supplemented with bronchial hyperresponsiveness and other testing in subsamples of the symptomatic and nonsymptomatic subjects. However, symptoms and bronchial hyperresponsiveness should usually be analysed separately rather than combined due to the poor agreement between bronchial hyperresponsiveness and clinical asthma. Eur Respir J 1999; 14: 951±957.

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“…In most of these large-scale twin studies, a diagnosis of asthma was based on self-reporting methodology. Subjects in these studies were not tested clinically; thus, recall bias could result in a decrease in the prevalence rates of the disease [23,24]. The heritability of IgE levels, bronchial hyperresponsiveness and skin test reactivity were 61, 66 and 72%, respectively, suggesting greater genetic than environmental influences on these traits.…”

Section: Presents Results Of Asthma Twin Studies [64±73]mentioning

confidence: 99%

“…Many epidemiological and genetic studies on asthma assess the asthma phenotypes by means of a questionnaire, assessing self-reported asthma, wheeze or doctor's diagnosis of asthma. Although the validity of questionnaires is relatively good [19±22], there is a possibility of underestimation or overestimation of asthma prevalence [23,24]. An advantage is that this method constitutes an easy and feasible approach and it can be used in large-scale studies.…”

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confidence: 99%

The importance of genetic influences in asthma

Los¹,

Koppelman²,

Postma³

1999

Eur Respir J

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Asthma is a complex genetic disorder in which the mode of inheritance is not known. Many segregation studies suggest that a major gene could be involved in asthma, but until now different genetic models have been obtained. Twin studies, too, have shown evidence for genetic influences in asthma, but have also revealed substantial evidence for environmental influences, in which nonshared environmental influences appeared to be important. Linkage, association studies and genome-wide screening suggest that multiple genes are involved in the pathogenesis of asthma. At least four regions of the human genome, chromosomes 5q31-33, 6p21.3, 11q13 and 12q14.3-24.1, contain genes consistently found to be associated with asthma and associated phenotypes. Not only genes associated with asthma but also genes which are involved in the development and outcome of asthma will be found in the future. This will probably provide greater insight into the identification of individuals at risk of asthma and early prevention and greater understanding for guiding therapeutic intervention in asthma. Exchange of information between researchers involved in the genetics of asthma is important because of mandatory agreement on phenotypes and analytical approaches. Genetics will contribute to the a better understanding and management of asthma in the future.

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Epidemiological diagnosis of asthma: Methodological considerations of prevalence evaluation

Cited by 20 publications

References 8 publications

Verifying a questionnaire diagnosis of asthma in children using health claims data

Verifying a questionnaire diagnosis of asthma in children using health claims data

Defining asthma in epidemiological studies

The importance of genetic influences in asthma

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