General Practice

Asthma after childhood pneumonia: six year follow up study

Christopher E Clark, general practitioner, ^a Jacqueline M Coote, consultant radiologist, ^b David A T Silver, consultant radiologist, ^b David M G Halpin, consultant physician. ^b

^a Mid Devon Medical Practice, Witheridge, Devon EX16 8AH, ^b Royal Devon and Exeter Hospital (Wonford), Exeter EX2 5DW

Correspondence to: C E Clark ceclark{at}sol.co.uk

Objective: To establish the long term cumulative prevalence of asthma in children admitted to hospital with pneumonia and to examine the hypothesis that some children admitted to hospital with pneumonia may be presenting with undiagnosed asthma.
Design: Prospective study of a cohort of children previously admitted to hospital with pneumonia, followed up by postal questionnaires to their general practitioners and the children or their parents.
Setting: General practices in southwest England.
Participants: 78 children admitted to the Royal Devon and Exeter Hospital between 1989 and 1991 with a diagnosis of pneumonia confirmed on independent review of x ray films.
Main outcome measures: Any diagnosis of asthma, use of any treatment for asthma, and asthma symptom scores.
Results: On the basis of a 100% response rate from general practitioners and 86% from patients or parents, the cumulative prevalence of asthma was 45%. A diagnosis of asthma was associated with a family history of asthma (odds ratio 11.23; 95% confidence interval 2.57 to 56.36; P=0.0002). Mean symptom scores were higher for all children with asthma (mean score 2.4; ²=14.88; P=0.0001) and for children with asthma not being treated (mean 1.4; ²=6.2; P=0.01) than for those without asthma (mean 0.2) .
Conclusions: A considerable proportion of children presenting to a district general hospital with pneumonia either already have unrecognised asthma or subsequently develop asthma. The high cumulative prevalence of asthma suggests that careful follow up of such children is worth while. Asthma is undertreated in these children; a structured symptom questionnaire may help to identify and reduce morbidity due to undertreatment.