The Natural History of Asthma in a Primary Care Cohort

Article Figures & Data

Table 1.

Respiratory Questionnaire Items

Symptom	Questions
Chronic cough	1. Did you usually, at least 5 days per week, cough (when getting up or during the day or night) during a period of at least 3 consecutive months?
Chronic phlegm	2. Did you usually, at least 5 days a week, bring up phlegm (when getting up, or during the day, or at night) for at least 3 consecutive months?
Chronic cough with phlegm	3. Have you coughed up phlegm, more than usually, for at least 3 consecutive weeks in the last 12 months?
Wheezing	4. Have you had wheezing in your chest in the last 12 months?
Tightness with wheezing	5. Have you had attacks of tightness with wheezing in your chest (attacks of asthma) in the last 12 months?
Breathless, age	6. Do you think that you get breathless more quickly than friends of your own age?
Breathless, upstairs	7. Have you been breathless going upstairs or riding a bike at a normal pace at least once in the last 12 months?
Breathless, flat	8. If yes, have you been breathless when you walked on the flat at a normal pace at least once in the last 12 months?
Smoking behavior	9. Do you smoke? Have you ever smoked, and did you stop smoking?

Table 2.

Hazard Ratio for Getting an Asthma Diagnosis (N = 500)

Variable	Hazard Ratio	95% Hazard Ratio Confidence Limits	PValue
* Symptomatic means ≥1 positive answer to the respiratory tract symptom questionnaire in 1989.
Symptomatic*	3.414	1.386, 8.410	.008
Bronchial hyperresponsiveness	1.278	0.519, 3.148	.59
Age	0.816	0.687, 0.969	.02
Male	1.230	0.499, 3.031	.65

Table 3.

Respiratory Tract Symptoms of 298 Active Patients Still in Practice Without an Asthma Diagnosis at Start of Study

Symptoms	BHR No. (%)	Non-BHR No. (%)	RR (95% CI)	PValue	*Symptomatic No. (%)**	Asymptomatic No. (%)	RR (95% CI)	PValue
BHR = bronchial hyperresponsiveness; RR = relative risk; CI = confidence interval.
* ≥1 positive answer to the respiratory tract symptom questionnaire in 1989.
† Includes otitis media, influenza, acute sinusitis, and laryngitis diagnoses.
‡ Includes pneumonia and acute bronchitis.
>4 upper respiratory tract infections†	16 (13)	21 (12)	1.1 (0.6–2.3)	.70	10 (16)	27 (11)	1.5 (0.7–3.2)	.34
Lower respriatory tract infections‡	18 (15)	16 (9)	1.8 (0.9–3.6)	.10	6 (10)	28 (12)	0.8 (0.3–2.0)	.46
Allergic rhinitis	18 (15)	21 (12)	1.3 (0.7–2.6)	.45	16 (25)	23 (10)	3.1 (1.5–6.4)	.001
Asthma	8 (7)	8 (5)	1.5 (0.5–4.1)	.40	8 (13)	8 (3)	4.1 (1.5–11.5)	.01
Total	121 (100)	177 (100)			63 (100)	235 (100)

The Article in Brief

In children and young adults, a single test for overreactiveness of the airway does not help predict whether the patient will develop respiratory tract illness, including asthma. Questionnaires about symptoms were more successful at predicting asthma and may be useful in practice.