What does adolescent undiagnosed-wheeze represent? Findings from the Isle of Wight Cohort

Raza, Abid, Kurukulaaratchy, Ramesh J., Grundy, Jane D., Clayton, C. Bernie, Mitchell, Frances A., Roberts, Graham, Ewart, Susan, Sadeghnejad, Alireza and Arshad, S Hasan (2012) What does adolescent undiagnosed-wheeze represent? Findings from the Isle of Wight Cohort. European Respiratory Journal, 40 (3), 580-588. (doi:10.1183/09031936.00085111). (PMID:22267759)

Abstract

We sought to characterise adolescent wheeze in the absence of asthma, which we termed “undiagnosed-wheeze”.

The Isle of Wight Birth Cohort (N=1456) was reviewed at 1, 2, 4, 10 and 18-years. Using questionnaire responses, “Asthma” was defined as “ever had asthma” plus either “wheezing in the last 12-months” or “taking asthma treatment in the last 12-months”, “Undiagnosed-wheeze” as “wheeze in the last 12-months” but “no” to “ever had asthma” and remaining subjects termed “non-wheezers”.

Undiagnosed-wheeze (prevalence 4.9%) accounted for 22% of wheezing at 18-years. This was largely adolescent-onset with similar symptom frequency and severity to diagnosed asthma. However, undiagnosed-wheezers had significantly higher FEV1/FVC ratio, less bronchodilator reversibility and bronchial hyper-responsiveness, and were less frequently atopic than asthmatics. Undiagnosed-wheezers had earlier smoking onset, higher smoking rates and monthly paracetamol use than non-wheezers. Logistic regression identified paracetamol use (OR 1.11, [95%CI 1.01–1.23]; p=0.03), smoking at 18-years (2.54, [1.19–5.41], p=0.02), rhinitis at 18 (2.82, [1.38–5.73], p=0.004) and asthmatic family history (2.26, [1.10–4.63], p=0.03) as significant independent risk factors for undiagnosed-wheeze.

Undiagnosed-wheeze is relatively common during adolescence, differs from diagnosed asthma and has strong associations to smoking and paracetamol use. Better recognition of undiagnosed-wheeze and assessment of potential relevance to adult health is warranted.

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Contributors

Author: Ramesh J. Kurukulaaratchy

Author: Graham Roberts

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