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Karin Yeatts, PhD; Carl Shy, MD; Mark Sotir, MPH; Stan Music, MD; Casey Herget, MSW, MPH

Arch Pediatr Adolesc Med. 2003;157:540-544.

Background  A growing body of evidence indicates that there are a substantial number of children who report asthma-like symptoms and are not diagnosed with asthma. However, there is little information on the health consequences of asthma-like symptoms for children with these symptoms and no asthma diagnosis.

Objective  To assess the prevalence and health consequences (school absences, sleep disturbances, activity limitations, physician visits, emergency department visits, and hospitalizations) of asthma-like symptoms among children with and without physician diagnosis.

Study Design  We surveyed 122 829 children aged 12 to 14 years in 499 North Carolina public middle schools. A standardized questionnaire (International Study of Asthma and Allergies in Childhood [ISAAC]) containing video scenes of adolescents experiencing asthma-like symptoms was adapted to include questions on health consequences.

Results  Seventeen percent (n = 21 184) reported current asthma-like symptoms with no diagnosis of asthma (during the last 12 months.) Eleven percent (n = 13 619) of the children reported physician-diagnosed asthma with current asthma-like symptoms. Of the children with asthma-like symptoms and no diagnosis of asthma, 20% missed a half day or more of school per month because of wheeze, 25% had limited activities because of wheeze once or more per month, and 32% had sleep disturbances because of wheeze in the last 4 weeks. Seven percent of children with current asthma-like symptoms but no diagnosis reported 1 or more emergency department visits for asthma-like symptoms, and 5% reported wheeze-related hospitalizations in the last year. Of children with physician-diagnosed asthma, almost half (47%) reported missing a half day or more of school in the last month. Thirty percent of physician-diagnosed children reported 1 or more emergency department visits in the last year for asthma-like symptoms.

Conclusions  The health consequences of asthma-like symptoms in children with no diagnosis are substantial; these children are essentially untreated. Better detection of this disease group by the medical community has the potential to improve health consequences for these children.

From the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill (Drs Yeatts and Shy and Mr Sotir); and Division of Public Health, North Carolina Department of Health and Human Services, Raleigh (Dr Music and Ms Herget). Dr Music is now affiliated with Merck & Co, Inc, West Point, Penn.

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