Childhood Asthma Often Goes Undiagnosed

Nearly a third of all cases of childhood asthma may go undiagnosed. The majority (69%) of missed diagnoses occurred among girls, pointing to what the researchers call a sex bias in the (traditional) diagnostic process. Other risk factors associated with a missed diagnosis included low levels of physical activity, serious (and stressful) family problems, and exposure to second-hand smoke in the home.

The researchers note that low levels of activity contribute to poor fitness and obesity. They speculate that many parents and physicians may erroneously attribute a child's post-exercise asthmatic wheezing or shortness of breath to a general lack of physical fitness. The researchers also speculate that family problems may reduce focus on a child's symptoms, and parents who smoke may be disinclined to get a doctor's advice regarding symptoms related to smoking in the family.

The presence of chronic cough, in the general absence of symptoms such as blocked nasal passages or watering or inflamed eyes, surfaced as yet another risk factor for undetected asthma. It seems likely that allergy affecting nose or eyes facilitates a diagnosis of asthma, both by promoting contact with a doctor and by increasing the doctor's awareness towards this diagnosis," the researchers explain. Cough, on the other hand, seemed to be particularly overlooked as an expression of asthma, by the physicians charged with caring for the children involved in the study.

British Medical Journal (1998;316:651-657)

COMMENT: If your child has a cough that lasts for more than several weeks and if does not respond to cough suppressants, the likelihood of asthma is VERY high. Other common symptoms include colds that always seem much worse than their brothers and sisters or other children their age. This is because most mild asthma does not surface until the body is compromised with a viral upper respiratory infection. Another clue is if your child is short of breath when it is very cold outside or when they are aggressively exercising. If all symptoms are present you can virtually 100% certain your child has asthma. Don't despair as there are many effective treatments. See the comment in the next article.

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