Possible presence of undiagnosed asthma in children in Japan

Main Article Content

Yuichiro Yagi https://orcid.org/0000-0002-0250-876X
Kazuyo Kuzume
Hideki Kumagai https://orcid.org/0000-0001-5309-8396

Keywords

children, FeNO, pulmonary function test, undiagnosed asthma

Abstract

Background: Asthma diagnosis in children is occasionally challenging, and the issue of undiagnosed asthma before adolescence has been poorly studied in Japan. The present study was conducted to investigate the possible presence of undiagnosed asthma in the general population of children living in a rural area of Japan.
Methods: The participants comprised 120 fourth graders aged 9–10 years (boys/girls: 63/57) attending five elementary schools in Yawatahama, Ehime, Japan. All the children underwent respiratory function tests and fraction of exhaled nitric oxide (FeNO) measurements. Based on the results of a questionnaire, the children were also categorized into groups depending on their allergic diseases.
The authors assessed the results of both the respiratory function tests and the FeNO measurements for children who were classified into the nonallergic group.
Results: A total of 76 (63%) children, who completed the tests appropriately, were included in the analysis. According to the report, among the 24 children in the nonallergic group, six (25%) showed abnormalities in respiratory tests. One had an abnormal % forced vital capacity (%FVC; <80%), three had abnormalities in both forced expiratory volume in 1 sec (FEV1)/FVC (<80%) and % maximal mid-expiratory flow (<65%), three had concave flow–volume curves, and one had a high FeNO measurement (41 ppb).
Conclusion: A certain proportion of Japanese elementary school children, categorized as having no allergy, showed respiratory function test abnormalities. A follow-up study is needed to determine the prognosis and outcomes of the children with these abnormalities.

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References

1. Global Initiative for Asthma. GINA guidelines. Global strategy for asthma management and prevention, 2019 [Internet].
[Accessed 2020 Feb 1]. Available from: https://ginasthma.org/
2. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, et al. An official ATS clinical practice guideline:
interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 2011 Sep 1;184(5):602–15. https://doi.org/10.1164/rccm.9120-11ST
3. Van Gent R, Van Essen-Zandvliet LEM, Rovers MM, Kimpen JLL, De Meere G, Van Der Ent CK. Poor perception of dyspnoea
in children with undiagnosed asthma. Eur Respir J. 2007 Nov;30(5):887–91. https://doi.org/10.1183/09031936.00031407
4. Aaron SD, Boulet LP, Reddel HK, Gershon AS. Underdiagnosis and overdiagnosis of asthma. Am J Respir Crit Care Med.
2018 Oct 15;198(8):1012–20. https://doi.org/10.1164/rccm. 201804-0682CI
5. McGeachie MJ, Yates KP, Zhou X, Guo F, Sternberg AL, Van Natta ML, et al. Patterns of growth and decline in lung function
in persistent childhood asthma. N Engl J Med. 2016 May 12;374(19):1842–52. https://doi.org/10.1056/NEJMoa1513737
6. Kanno N, Yoshihara S, Arisaka O, Noda M. Investigation of factors childhood asthma persisting into adulthood. Jpn J Allerg. 2010 Jan;59(1):25–36 (in Japanese).
7. Nolte H, Nepper-Christensen S, Backer V. Unawareness and undertreatment of asthma and allergic rhinitis in a general
population. Respir Med. 2006 Feb;100(2):354–62. https://doi.org/10.1016/j.rmed.2005.05.012
8. van Schayck CP, van Der Heijden FM, van Den Boom G, Tirimanna PR, van Herwaarden CL. Underdiagnosis of asthma:
is the doctor or the patient to blame? The DIMCA project. Thorax. 2000 Jul;55(7):562–5. https://doi.org/10.1136/thorax.55.7.562
9. Adams RJ, Wilson DH, Appleton S, Taylor A, Dal Grande E, Chittleborough CR, et al. Underdiagnosed asthma in South
Australia. Thorax. 2003 Oct;58(10):846–50. https://doi. org/10.1136/thorax.58.10.846
10. de Marco R, Cerveri I, Bugiani M, Ferrari M, Verlato G. An undetected burden of asthma in Italy: the relationship
between clinical and epidemiological diagnosis of asthma. Eur Respir J. 1998 Mar;11(3):599–605.
11. van Gent R, van Essen LEM, Rovers MM, Kimpen JLL, van der Ent CK, de Meer G. Quality of life in children with undiagnosed and diagnosed asthma. Eur J Pediatr. 2007 Aug;166(8):843–8. https://doi.org/10.1007/s00431-006-0358-y
12. Yawatahama City Official Webite [Internet]. [Accessed 2020 Feb 27]. Available from: http://www.city.yawatahama.ehime.
jp/ (in Japanese).
13. Nishima S. A study on the prevalence of allergic diseases in school children in western districts of Japan – comparison
between the studies in 1992, 2002 and 2012 with the same methods and same districts. Jpn J Pediatr Allergy Clin Immunol. 2003;17(3):255–68. https://doi.org/10.3388/
jspaci.17.255
14. Takase M. Spirometric reference values and the cut-off indexes in Japanese children. Jpn J Pediatr Pulmonol.
2010;21:17–22 (in Japanese).
15. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J.
2005 Aug;26(2):319–38.
16. Arakawa H, Adachi Y, Ebisawa M, Fujisawa T. Japanese guidelines for childhood asthma 2020. Allergol Int. 2020;69:314–30. https://doi.org/10.1016/j.alit.2020.02.005
17. McNulty W, Usmani OS. Techniques of assessing small airways dysfunction. Eur Clin Respir J. 2014 Oct 17;1:1. https://doi.
org/10.3402/ecrj.v1.25898
18. van Dalen C, Harding E, Parkin J, Cheng S, Pearce N, Douwes J. Suitability of forced expiratory volume in 1 second/forced vital capacity vs percentage of predicted forced expiratory volume in 1 second for the classification of asthma severity in adolescents. Arch Pediatr Adolesc Med. 2008 Dec;162(12):1169–74. https://doi.org/10.1001/archpedi.162.12.1169
19. Siersted HC, Boldsen J, Hansen HS, Mostgaard G, Hyldebrandt N. Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study. BMJ. 1998 Feb 28;316(7132):651–5. https://doi.org/10.1136/bmj.316.7132.651
20. Kampschmidt JC, Brooks EG, Cherry DC, Guajardo JR, Wood PR. Feasibility of spirometry testing in preschool children.
Pediatr Pulmonol. 2016 Mar;51(3):258–66. https://doi.org/10.1002/ppul.23303