285 SEX-DEPENDENT UNDERDIAGNOSE IN CHILDHOOD ASTHMA – WHO IS RESPONSIBLE?

Abstract

Objectives: Analysis of possible reasons for the reported sex differences in diagnosis and treatment of childhood asthma. Methods: A cluster sample was selected and stratified by age, sex and asthma symptoms. The children performed a flow-volume curve. An extended questionnaire was applied. A final diagnosis of bronchial asthma based on reported symptoms was made by the investigators. Results: A response rate of 98.5% gave a total of 439 children (218 m, 221 f). The only sex difference in 19 asthma symptoms was found for current (within previous 12 months) allergen induced cough and for the lifetime prevalence of chest tightness during infections being both more prevalent in boys. Hayfever and atopic eczema were equally prevalent in both sexes. No sex difference could be found in lung function testing. The final diagnosis of bronchial asthma was made in 50% of boys and in 52% of girls. In contrast, the prevalence of the reported asthma diagnosis was significantly higher in boys than in girls (19% vs 10%. p < 0.01). Mothers referral rate to the doctor showed no sex difference for wheeze or for other complaints. But the diagnostic procedures were significantly different according to the sex of the child: in boys significantly more lung function testing (10% vs 4%, p < 0.01). allergy skin testing (23% vs 14%, p < 0.02), and IgE analysis by RAST (17% vs 6%, p < 0.05) were performed. Chest X-rays were reported equally often in both sexes (14% vs 15%). Conclusion: Sex dependent diagnostic management by the family doctor seems to be a major cause for the underdiagnosis of asthma in girls.