Prevalence of and factors associated with underdiagnosis of pediatric asthma in Batumi, Georgia

Main Article Content

J.E. Zejda
V. Beridze
T. Bakhtadze
S. Beridze
L. Abuladze
N. Partenadze
J. Lawson

Keywords

Asthma, Children, Underdiagnosis

Abstract

Background and objective: A recent survey in Batumi, Georgia showed a low prevalence of asthma in children (1.8%). A potential explanation is underdiagnosis of asthma. To investigate this, we conducted a follow up to the survey with the objective of estimating the level of childhood asthma underdiagnosis and to describe factors related to it.


Methods: Subjects included 437 survey participants who had a history of asthma-like symptoms and no diagnosis of asthma. All children underwent clinical examination (spirometry, skin prick tests, FeNO measurement) to identify new cases of asthma. The distribution of host and environmental factors was compared between the group with newly identified asthma and a group of 59 children with previously known asthma (diagnosed asthma).


Results: Clinical investigation identified 107 cases of undiagnosed asthma. The corrected asthma prevalence estimate was 5.1% (95%CI: 4.4%-5.9%) suggesting that 65% of asthma cases were undiagnosed. Compared to children with diagnosed asthma, children with undiagnosed asthma were younger (8.2 ± 1.6 vs. 9.3 ± 2.1; p = 0.0005), had less frequent history of allergic disorders (38.3% vs. 64.4%; p = 0.001), and a lower prevalence of parental asthma (1.8% vs. 8.4%; p = 0.04). The groups did not differ in terms of environmental characteristics except for more exposure to passive smoking in the undiagnosed asthma group (p = 0.01). Multivariate analysis confirmed results of simple analyses.


Conclusion: In Batumi, 65% of children with asthma remain undiagnosed. Older age of a child, coexisting allergic disorders, and parental asthma seem to facilitate diagnosis. Implementation of current diagnostic guidelines should improve diagnostic accuracy of pediatric asthma in Batumi.

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References

1. Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2009;64(6):476-83.

2. Asher MI, Monteforte S, Bjorksten B, Lai CK, Strachan DP, Weiland S, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;368(9537):733-43.

3. Lawson JA, Brozek G, Shpakou A, Fedortsiv O, Vlaski E, Beridze V, et al. An international comparison of asthma, wheeze and breathing medication use among children. Respir Med. 2017;133:22-8.

4. Vasar M, Julge K, Kivivare M, Otter K. Regional differences in diagnosing asthma and other allergic diseases in Estonian schoolchildren. Medicina (Kaunas). 2011;47(12):661-6.

5. Beridze V, Abuladze L, Partenadze N, Bakhtadze T, Lawson J, Zejda JE. Childhood asthma in Batumi, Georgia: prevalence and environmental correlates. J Asthma. 2018;55(1):43-9.

6. Leonardi GS, Houthuijs D, Nikiforov B, Volf J, Rudnai P, Zejda J, et al. Respiratory symptoms, bronchitis and asthma in children of Central and Eastern Europe. Eur Respir J. 2002;20(4): 890-8.

7. Bro˙zek G, Lawson J, Shpakou A, Fedortsiv O, Hryshchuk L, Rennie D, et al. Childhood asthma prevalence and risk factors in three Eastern European countries - the Belarus, Ukraine, Poland Asthma Study (BUPAS): an international prevalence study. BMC Pulm Med. 2016;16:11. Published 2016 Jan 14.

8. Bro˙zek GM, Farnik M, Lawson J, Zejda JE. Underdiagnosis of childhood asthma: a comparison of survey estimates to clinical evaluation. Int J Occup Med Environ Health. 2013;26(6): 900-9.

9. 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;166(8):843-8.

10. Jose BP, Camargos PA, Cruz Filho AA, Correa RA. Diagnostic accuracy of respiratory diseases in primary health units. Rev Assoc Med Bras. 2014;60(60):599-612.

11. Gerald JK, Sun Y, Grad R, Gerald LB. Asthma morbidity among children evaluated by asthma case detection. Pediatrics. 2009;124(5):e927-33.

12. Baldacci S, Maio S, Simoni M, Cerrai S, Sarno G, Silvi P, et al. The ARGA study with general practitioners: impact of medical education on asthma/rhinitis management. Respir Med. 2012;106(6):777-85.

13. Aaron SD, Boulet LP, Reddel HL, Gershon AS. Underdiagnosis and overdiagnosis of asthma. Am J Resp Crit Care Med. 2018;198(8):1012-20.

14. Annesi-Maesano I, Sterlin C, Caillaud D, de Blay F, Lavaud F, Charpin D, et al. Factors related to under-diagnosis and under-treatment of childhood asthma in metropolitan France. Multidiscip Resp Med. 2012;7(1):24-36.

15. Zejda JE, Farnik M, Smółka I, Lawson J, Bro˙zek G. Sociodemographic factors related to under-diagnosis of childhood asthma in Upper Silesia, Poland. Ann Agric Environ Med. 2017;24(2):171-5.