Timeliness of diagnosis of asthma in children and its predictors


Dr Young J. Juhn
Division of Community Pediatric and Adolescent Medicine
Department of Pediatric and Adolescent Medicine
Mayo Clinic
200, 1st Street SW
Rochester, MN 55905


Background:  There is a paucity of literature using medical records to evaluate the timeliness of asthma diagnosis in children and the predictors associated with timeliness of asthma diagnosis.

Methods:  Subjects were obtained from a convenience sample of 839 children, aged 5–13 years. We conducted comprehensive medical record reviews for these children to determine their asthma status by applying predetermined criteria for asthma. Predictors were evaluated for an association with timeliness of asthma diagnosis.

Results:  Of 839 children, 276 children met the criteria for asthma before 18 years of age. Of these subjects, 97 had timely diagnosis of asthma while 179 did not have timely diagnosis of asthma with the median delay of 3.3 years. Children with definite asthma at the time of index date was three times more timely to be diagnosed with asthma [hazard ratios (HR) 3.3, 95% CI: 2.43–4.47, < 0.001], compared to those with probable asthma. Children with a family history of asthma were more timely to be diagnosed with asthma (HR 1.36, 95% CI: 1.03–1.8, = 0.031). Children with exercise-induced wheezing or bronchospasm were more timely to be diagnosed with asthma (HR 1.79, 95% CI: 0.95–3.36, = 0.07), compared to those with spasmodic (or bronchospastic) cough.

Conclusions:  Many asthmatic children are not diagnosed with asthma in a timely manner, especially in those without the commonly recognized factors associated with asthma. Health care providers need to be reminded that asthma can still occur in those without commonly recognized risk factors. Asthma guidelines need to emphasize this aspect.