Predictive value of respiratory symptoms for the diagnosis of pollen-induced seasonal asthma among children and adults in Inner Mongolia

Abstract

BackgroundThe diagnosis of asthma is made on the basis of variable respiratory symptoms and supported by objective evidence of variable airflow limitation. However, spirometry and bronchoprovocation tests may not be routinely available in resource-scarce settings or in the context of large-scale epidemiological studies. There is a gap in knowledge about the predictive value of respiratory symptoms for the diagnosis of pollen-induced asthma.ObjectiveThe aim of this study was to investigate the predictive value of self-reported respiratory symptoms for diagnosing pollen-induced asthma.Patients and methodsWe recruited 1,161 patients with respiratory symptoms who presented to the respiratory medicine outpatient clinic of two central hospitals in Inner Mongolia during the pollen season of July–September 2015. All patients were interviewed by a respiratory physician and completed a questionnaire survey, lung function tests and skin prick tests for common inhaled allergens.ResultsA total of 392 patients (33.8%) were diagnosed with asthma and 292 (25.2%, 160 adults, 132 children) with pollen-induced asthma. Respiratory symptoms of cough, wheezing, dyspnea, chest pain and nocturnal awakenings due to breathlessness were all associated with increased odds of being diagnosed with pollen-induced asthma, with cough being the most common symptom in both adults and children, giving a sensitivity of 90.6% in adults and 88.6% in children. Wheezing was the most specific symptom (78% and 89.5% in adults and children, respectively) compared to other symptoms. Overall, the positive predictive value of respiratory symptoms was poor for diagnosing pollen-induced asthma, with the exception of wheezing in children which had a high positive predictive value of 72.7%.ConclusionCough was the predominant symptom in adults and children with pollen-induced asthma. Wheezing was a reliable predictor of pollen-induced asthma in children. In adults, respiratory symptoms were not sufficiently reliable for diagnosing pollen-induced asthma.

Diagnosis of asthma in children: the contribution of a detailed history and test results

“…Only three other studies assessed the accuracy of symptoms to diagnose asthma in school-aged children consecutively referred to paediatric hospitals [20][21][22]. They all found that reported wheeze was sensitive (ranging 0.75-0.86) but not specific (0.64-0.73) and that frequent wheeze and awakening due to dyspnoea were specific (0.84-0.90) but not sensitive (0.33-0.54), which is in line with our findings.…”

“…Symptom definitions differed between studies, especially those for cough, which results in a wide range of sensitivities and specificities that cannot be compared [20][21][22]. Five other studies assessed the accuracy of diagnostic tests in school aged children.…”

Role of Honey in Nocturnal Cough in Paediatric Patients: A Critical Review

“…6 A bacterial or viral infection can cause pathological Cough, the presence of an irritant or allergen, or both. 7 Acute Respiratory infections can affect the upper or lower respiratory tract, and the cough results might be productive or non-productive for sputum. A cough that does not produce phlegm is typically called a "dry" cough.…”

Phenotypes of Eosinophils in the Diagnosis of Atopic Bronchial Asthma in Children

“…The diagnosis of the disease in pediatric patients is usually based on clinical symptoms and precise anamnesis. Pulmonary function tests which are commonly used in adults has an age-limit for children and usually are not used for toddlers [3,4].…”