Diagnosis of asthma in children
BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39234.651412.AE (Published 26 July 2007) Cite this as: BMJ 2007;335:198
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In 28th July 2007 issue of the Journal, Dr. Townshend and colleagues
review diagnostic procedures to diagnose asthma in children with wheeze
and do recommendations to assess disease severity when children do not
adequetely respond to initial treatment. (1)
We agree with the authors that the listed investigations could
contribute to more insight in securing the diagnosis and the disease
severity of children. However, we would like to add that insufficient
adherence to preventive measures, poor medical compliance and poor inhaler
technique can also result in non adequate response to initial
treatment.(2;3) Since, the suggested additional diagnostic procedures not
only result in information, but also are inconvenient for the child (and
parent), and cause economic burden for the society at large, unnecessary
tests should be avoided.
Furthermore, recent guidelines like the Global Initiative for Asthma
(GINA) guidelines(4) have begun placing greater emphasis on the concept
asthma control in stead of asthma severity. Although there is no universal
definition for asthma control, it is generally considered to reflect
disease activity expressed as fluctuations in symptoms and the degree to
which these symptoms limit activities, disturb sleep or require the use of
a rescue inhaler (eg short-acting ß agonist). As the goal for all patients
with asthma is to achieve and maintain optimal asthma control, the
diagnostic investigations of children with asthma should not only be
focused on assessing asthma severity but also on assessing asthma
control(4).
The previously mentioned factors for treatment non-response
(insufficient adherence to preventive measures, poor medical compliance
and poor inhaler technique) are common in pediatric asthma and are related
to poor asthma control.(5) Therefore during the diagnostic process of
children with wheeze that do not respond to initial treatment, there is
also need to collect information on these factors.
Lotte van den Nieuwenhof, MD
Lisette van den Bemt, MSc
L.vandennieuwenhof@hag.umcn.nl
Reference List
(1) Townshend J, Hails S, McKean M. Diagnosis of asthma in children.
BMJ 2007 Jul 28;335(7612):198-202.
(2) van Schayck CP, Der Heijden FM, van den BG, Tirimanna PR, van
Herwaarden CL. Underdiagnosis of asthma: is the doctor or the patient to
blame? The DIMCA project. Thorax 2000 Aug;55(7):562-5.
(3) Boulet LP. Perception of the role and potential side effects of
inhaled corticosteroids among asthmatic patients. Chest 1998
Apr;113(3):587-92.
(4) GINA Report. Global strategy for
asthma management and prevention. National Institutes of Healt, National
Heart, Lung, and Blood Institute. Revised 2006. www.ginasthma.com
(5) Kuehni CE, Frey U. Age-related differences in perceived asthma
control in childhood: guidelines and reality. Eur Respir J 2002
Oct;20(4):880-9.
Competing interests:
None declared
Competing interests: No competing interests
Editorial blue pencil
Never use a simple word when you can use a complicated one.
The word "phenotype(s)" in relation to asthma occurs no less than eight times in
this article.
A phenotype is the entire physical, biochemical, and physiological makeup of an
organism produced by the interaction of genes and the environment, or the
expression of a single gene or gene pair. It cannot properly be applied to a
symptom, physical sign, or diagnosis.
I wonder what meaning the authors intend to convey by, for example, "Different
phenotypes of wheeze are seen in childhood." which would not be more clearly
put as "Different types of wheeze are seen in childhood."?
Competing interests:
None declared
Competing interests: No competing interests