Asthma diagnosis and treatmentSpirometric criteria for asthma: Adding further evidence to the debate
Section snippets
Methods
The methods of the North West Adelaide Health (Cohort) Study have been described previously.37 Briefly, all households in the northwest region of Adelaide that were listed in the electronic “White Pages” telephone directory were eligible for selection. A letter of introduction was sent to the household of each randomly selected telephone number. Selected households received a telephone call inviting the person with the most recent birthday and who was at least 18 years of age to participate in
Results
Complete spirometric and self-reported CA data were available for 4002 (98.5%) participants. Current asthma was reported by 9.4% (n = 380) of the study participants. Table I shows that the prevalence of reversibility in the population according to differing criteria ranged from 2.0% for the 400 mL or greater criterion to 6.2% for the 9% of predicted value or greater criterion. The prevalence of significant bronchodilator responsiveness (ie, reversibility without a CA diagnosis) ranged from 1.3%
Discussion
It is clear from this study that the 4 reversibility criteria classify quite different persons, which, although intuitive, has not been previously demonstrated in a large representative population sample. This has considerable implications for clinical practice and for the interpretation of epidemiologic studies examining asthma prevalence. Consistent with previous studies in COPD,25, 30 bronchodilator reversibility was normally distributed in the population. Consequently, there is likely to be
References (52)
- et al.
Underdiagnosis of asthma in the elderly
Br J Dis Chest
(1987) - et al.
Underdiagnosis and undertreatment of asthma in the elderly. Cardiovascular Health Study Research Group
Chest
(1999) - et al.
Asthma in the elderly: underperceived, underdiagnosed and undertreated; a community survey
Respir Med
(1998) - et al.
Probability of asthma based on methacholine challenge
Chest
(1992) - et al.
Prior diagnosis and treatment of patients with normal results of methacholine challenge and unexplained respiratory symptoms
Chest
(1996) - et al.
Unimodal distribution of bronchial responsiveness to inhaled histamine in a random human population
Chest
(1983) - et al.
A discriminant analysis applied to methacholine bronchoprovocation testing improves classification of patients as normal, asthma, or COPD
Chest
(1992) - et al.
The effect of age on methacholine response
J Allergy Clin Immunol
(1985) - et al.
Evaluation of the severity of asthma: patients versus physicians
Am J Med
(1980) - et al.
Acute postbronchodilator changes in pulmonary function parameters in patients with chronic airways obstruction
Chest
(1988)
The combination of ipratropium and albuterol optimizes pulmonary function reversibility testing in patients with COPD
Chest
Comparison of the efficacy, tolerability, and safety of formoterol dry powder and oral, slow-release theophylline in the treatment of COPD
Chest
Long-term treatment benefits with tiotropium in COPD patients with and without short-term bronchodilator responses
Chest
Differences in health estimates using telephones and door-to-door survey methods—a hypothetical exercise
Aust N Z J Public Health
A symptom-based measure of the severity of chronic lung disease: results from the Veterans Health Study
Chest
Asthma and asthma-like symptoms in adults assessed by questionnaires. A literature review
Chest
Asthma in older people
Clin Exp Allergy
Underdiagnosis of chronic obstructive pulmonary disease: a rationale for spirometry as a screening tool
Can Respir J
Continuing the debate about measuring asthma in population studies
Thorax
Bronchial reactivity to inhaled histamine: a method and clinical survey
Clin Allergy
Diagnosis of asthma and chronic obstructive pulmonary disease in general practice
Br J Gen Pract
Reported diagnosis of previous asthma in a sample of the Italian general population
Monaldi Arch Chest Dis
Airway responsiveness and peak flow variability in the diagnosis of asthma for epidemiological studies
Eur Respir J
Factors that contribute to inhibition of methacholine-induced bronchoconstriction
Am Rev Respir Dis
Relationship of airway hyperresponsiveness to respiratory symptoms and diurnal peak flow variation in patients with obstructive lung disease. The Dutch CNSLD Study Group
Am Rev Respir Dis
The relationship of nonspecific bronchial responsiveness to the occurrence of respiratory symptoms and decreased levels of pulmonary function. The Normative Aging Study
Am Rev Respir Dis
Cited by (0)
Supported by the University of Adelaide and the South Australian Department of Health.