PMID- 19373639
OWN - NLM
STAT- MEDLINE
DCOM- 20090507
LR  - 20090417
IS  - 1532-4303 (Electronic)
IS  - 0277-0903 (Linking)
VI  - 46
IP  - 3
DP  - 2009 Apr
TI  - Body mass index-percentile and diagnostic accuracy of childhood asthma.
PG  - 291-9
LID - 10.1080/02770900802712963 [doi]
AB  - OBJECTIVE: To determine whether high BMI-percentile is associated with 
      misdiagnosis of asthma among children referred to an asthma specialist. METHODS: 
      We queried the electronic records of children 8 to 18 years of age seen by a 
      Nemours pediatric pulmonologist. All visits during a 6-year period with the chief 
      complaint of asthma, or an asthma-like symptom such as wheeze, cough, or dyspnea, 
      were included. We collected spirometry, blood counts, and immunoglobulin E (IgE) 
      if available. We determined whether the child had referring physician-diagnosed 
      asthma, specialist-diagnosed asthma, or both. Specialist-diagnosed asthmatics who 
      met additional objective "gold-standard" criterion were labeled strict-criterion 
      asthma. RESULTS: Prevalence of high BMI-percentile was extremely common in all 
      defined asthma groups, even those meeting strict criteria for diagnosis. 
      Referring physician-diagnosed asthmatics did not have higher rates of obesity, 
      and referring physician-diagnosed asthmatics had objective indicators of asthma 
      that were the same as asthmatics diagnosed by a specialist. There was good 
      diagnostic correlation between referring physicians and asthma specialists that 
      was not affected by BMI. Among specialist-diagnosed asthmatics, increased 
      BMI-percentile associated with significantly reduced forced expiratory volume in 
      1 second (FEV(1)), forced expiratory flow during the middle half of the forced 
      vital capacity (FEF(25 - 75)), and FEV(1)/forced vital capacity (FVC); and 
      significantly increased total blood leukocytes, neutrophils, and platelets 
      compared to leans. For all 2,258 referrals, the estimated odds ratio of receiving 
      a specialist-diagnosis of asthma increased by 0.4% with each increasing BMI 
      percentile. CONCLUSIONS: Referring physicians do not appear to erroneously 
      diagnose children with asthma due to overweight status. Our data confirm that 
      overweight status is extremely high in children with true asthma and likely 
      increases the risk for true asthma. Although these data cannot discern causality, 
      high BMI-percentile is associated with greater airflow obstruction and elevated 
      markers of systemic inflammation that could contribute to underlying mechanisms 
      of asthma.
FAU - Lang, Jason E
AU  - Lang JE
AD  - Division of Pulmonology, Allergy & Immunology, Nemours Children's Clinic, 
      Jacksonville, FL 32207, USA. jelang@nemours.org
FAU - Feng, Hua
AU  - Feng H
FAU - Lima, John J
AU  - Lima JJ
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Asthma
JT  - The Journal of asthma : official journal of the Association for the Care of 
      Asthma
JID - 8106454
RN  - 37341-29-0 (Immunoglobulin E)
SB  - IM
MH  - Adolescent
MH  - Asthma/*complications/*diagnosis
MH  - Blood Cell Count
MH  - *Body Mass Index
MH  - Child
MH  - Female
MH  - Humans
MH  - Immunoglobulin E
MH  - Male
MH  - Obesity/*complications
MH  - Predictive Value of Tests
MH  - Prevalence
MH  - Referral and Consultation
MH  - Respiratory Function Tests
MH  - Retrospective Studies
MH  - Spirometry
EDAT- 2009/04/18 09:00
MHDA- 2009/05/08 09:00
CRDT- 2009/04/18 09:00
PHST- 2009/04/18 09:00 [entrez]
PHST- 2009/04/18 09:00 [pubmed]
PHST- 2009/05/08 09:00 [medline]
AID - 910511698 [pii]
AID - 10.1080/02770900802712963 [doi]
PST - ppublish
SO  - J Asthma. 2009 Apr;46(3):291-9. doi: 10.1080/02770900802712963.