Who Gets Diagnosed With Asthma? Frequent Wheeze Among Adolescents With and Without a Diagnosis of Asthma

Yeatts, Karin; Davis, Kourtney J.; Sotir, Mark J.; Herget, Casey; Shy, Carl M.

doi:10.1542/peds.111.5.1046

Cited by 123 publications

(92 citation statements)

References 40 publications

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“…Our data, however, showed that asthma medication was used to treat not only asthma and asthmatic complaints but also other respiratory morbidities, such as acute bronchitis and acute upper respiratory tract infections. These fi ndings are similar to fi ndings from other studies showing a discrepancy between asthma medication use and asthma diagnosis, 15,16 and they could indicate off-label use and overtreatment. Studies evaluating the effectiveness of asthma medication for indications other than asthma are inconclusive.…”

Section: Respiratory Morbidities Other Than Asthmasupporting

confidence: 90%

“…[12][13][14] Other studies have reported a mismatch between asthma medication use and a diagnosis of asthma. [15][16][17] A key question driven by these observations is whether this diversity seen in pediatric asthma therapy is mainly determined by the patient itself, the family, or the treating physician. The attitude of the physician or preferences of the caregivers or parents could play a much larger role in the decisionmaking process at a young age, when the diagnosis is uncertain, than at an older age, when the diagnosis of asthma can be more fi rmly established.…”

Section: Pr Escr Ibing a S T Hm A Medic At Ion To Chil Dr Enmentioning

confidence: 99%

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What Drives Prescribing of Asthma Medication to Children? A Multilevel Population-Based Study

Zuidgeest¹,

Dijk²,

Spreeuwenberg³

et al. 2009

The Annals of Family Medicine

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PURPOSE Diagnosing asthma in children with asthmatic symptoms remains a challenge, particularly in preschool children. This challenge creates an opportunity for variability in prescribing. The aim of our study was to investigate how and to what degree patient, family, and physician characteristics infl uence prescribing of asthma medication in children. METHODSWe undertook a multilevel population-based study using the second Dutch national survey of general practice (DNSGP-2), 2001. Participants were 46,371 children aged 1 to 17 years belonging to 25,537 families registered with 109 general practitioners. Using a multilevel multivariate logistic regression analysis with 3 levels, our main outcome measure was the prescribing of asthma medication, defi ned as at least 1 prescription for β 2 -adrenergic agonists, inhaled corticosteroids, cromones, or montelukast during the 1-year study period. RESULTSWe identifi ed characteristics signifi cantly associated with prescribing asthma medication on all 3 levels (child, family, and physician). The variance in prescribing among physicians was signifi cantly higher with children who were younger than 6 years than with children aged 6 years and older (95% CI, 3.5%-25.2% vs 2.4%-13.4%). Several diagnoses other than asthma and asthmatic complaints were strongly associated with prescribing asthma medication, including bronchitis/bronchiolitis (OR = 9.04; 95% CI, 7.57-10.8) and cough (OR = 6.51; 95% CI,).CONCLUSIONS Our study shows a much higher variance in prescribing patterns among general practitioners for children younger than 6 years compared with older children, which could be a direct result of the diagnostic complexities found in young children with asthmatic symptoms. Thus diagnostic gaps may lead to more physician-driven prescribing irrespective of the clinical context.

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Section: Respiratory Morbidities Other Than Asthmasupporting

confidence: 90%

Section: Pr Escr Ibing a S T Hm A Medic At Ion To Chil Dr Enmentioning

confidence: 99%

What Drives Prescribing of Asthma Medication to Children? A Multilevel Population-Based Study

Zuidgeest¹,

Dijk²,

Spreeuwenberg³

et al. 2009

The Annals of Family Medicine

View full text Add to dashboard Cite

show abstract

“…Consistent with a growing body of evidence [14][15][16] these asthmatics also showed tracking of impaired childhood lung function into adulthood with impaired adolescent lung function gain. Diagnostic labelling of asthma in our population might appear better than anticipated from some studies [22][23][24]; however, that primary care practitioners can reliably distinguish wheezing representing asthma has been shown in a paediatric population by NYSTAD et al [31]. In our population too, typical clinical features of asthma led to asthma diagnosis and therapy.…”

Section: Discussionmentioning

confidence: 48%

“…Several studies have reported substantial prevalence of childhood, adolescent and adult undiagnosed asthma; wheeze in the absence of diagnosed asthma [22][23][24]. However, we believe that undiagnosed asthma may not be the proper classification for all who wheeze in adolescence but have not been diagnosed with asthma.…”

mentioning

confidence: 81%

What does adolescent undiagnosed wheeze represent? Findings from the Isle of Wight Cohort

et al. 2012

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“…Yeatts et al found that 6% of adolescents with frequent wheezing had no physician diagnosis of asthma. 35 Finally, some medications used for asthma in children may be used for other respiratory disorders (i.e., cystic fibrosis or bronchiolitis). As a result, we may be overestimating the use of these medications for asthma, and thus, overestimating asthma severity.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Asthma Surveillance Using Medicaid Claims

2005

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Objective. The purpose of this study was to describe the prevalence of asthma among children using alternative case definitions applied to administrative claims data, and to assess year-to-year classification concordance. Methods. This study was a retrospective cohort analysis of 357,729 children 0–18 years using 2001–2002 Michigan Medicaid claims. Asthma cases were classified using six alternative definitions based on outpatient, emergency department, inpatient, and pharmacy claims for asthma, including the Health Plan Employer Data Information Set (HEDIS) persistent asthma criteria commonly used for assessments of asthma health care quality: at least one asthma inpatient admission or emergency department visit, four or more asthma medications events, or four asthma outpatient visits and two asthma medication events. Results. Overall, asthma prevalence varied widely between alternative case definitions, ranging from 14.9% based on claims evidence of any type of asthma utilization to 3.7% when restricted to those with four or more asthma medication dispensing events. Among cases meeting HEDIS persistent asthma criteria in 2001, 55.5% met these criteria in 2002. Those with four or more asthma medication dispensing events had the best overall classification concordance between 2001 and 2002. Utilization of asthma services and prevalence estimates were highest among children younger than 5 years old, but year-to-year classification concordance was poorest among these cases (p<0.0001), irrespective of case definition. Conclusions. While overall asthma prevalence may remain relatively stable from year to year, individuals may not be classified consistently as cases over time, regardless of case definition. Studies that identify asthma cases in one year and assess asthma outcomes in a subsequent year may introduce substantial bias as a result of case misclassification. Among the case definitions considered in this study, our findings suggest that this bias is minimized among cases classified using the four or more asthma medication dispensing events criterion.

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Who Gets Diagnosed With Asthma? Frequent Wheeze Among Adolescents With and Without a Diagnosis of Asthma

Cited by 123 publications

References 40 publications

What Drives Prescribing of Asthma Medication to Children? A Multilevel Population-Based Study

What Drives Prescribing of Asthma Medication to Children? A Multilevel Population-Based Study

What does adolescent undiagnosed wheeze represent? Findings from the Isle of Wight Cohort

Pediatric Asthma Surveillance Using Medicaid Claims

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