Health consequences for children with undiagnosed asthma-like symptoms.

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.