Validation of questionnaire and bronchial hyperresponsiveness against respiratory physician assessment in the diagnosis of asthma
Abstract
BACKGROUND: The Tasmanian Asthma survey (TAS) and the International Study of Asthma and Allergies in Childhood (ISAAC) have used questionnaires to measure the prevalence of asthma in adults and children. We have investigated the validity of these questionnaires by comparing response to questionnaire with a physician assessment of asthma status in the past 12 months. METHODS: Ninety-three adults were given the TAS questionnaire to complete and 361 children were given the ISAAC questionnaire. Ninety-one adults and 168 children completed bronchial challenge with hypertonic saline. A consultation with a respiratory physician blinded to the results of the questionnaire and bronchial challenge was given to all subjects. RESULTS: In both adults and children, questionnaires showed high agreement with respiratory physician diagnosis with respect to asthma symptoms in the past 12 months. For the TAS questionnaire the positive and negative predictive values (95% confidence limits) for physician diagnosis for adults were 0.89 (0.68-0.98) and 0.94 (0. 86-0.98) respectively. The instrument was also sensitive 0.80 (0. 58-0.93) and highly specific 0.97 (0.90-0.99). For the ISAAC questionnaire the positive and negative predictive vales for physician diagnosis of asthma in children were 0.61 (0.50-0.71) and 0.94 (0.88-0.98) respectively. Sensitivity and specificity were 0.85 (0.73-0.93) and 0.81 (0.76-0.86) respectively. Compared to the physician diagnosis, the sensitivity of bronchial hyperresponsiveness (BHR) for asthma was low for adults 0.39 (0.21-0. 61) and children 0.54 (0.48-0.67) as were the positive predictive values: 0.55 (0.31-0.79) for adults and 0.64 (0.449-0.77) for children. A definition of asthma requiring both a positive questionnaire response and BHR was highly specific but not sensitive for adults 0.37 (0.20-0.59) or children 0.47 (0.35-0.60). CONCLUSIONS: Both the TAS and ISAAC questionnaires are valid instruments for the determination of asthma symptoms in the past 12 months.
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Current asthma defined by wheezy breathing in the last 12 months in the absence of a cold is a more sensitive definition than using doctor-diagnosed asthma.
“For example, current asthma defined by “wheezy breathing in the last 12 months in the absence of a cold” is a more sensitive definition than using “doctor-diagnosed asthma” as they do not rely on the individual to seek health advice (18)”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [18]
Doctor-diagnosed asthma is a more specific definition than wheezy breathing.
“while the latter is a more specific definition.”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [18]
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Self-citation
- Authors
- JENKINS, M. A., CLARKE, J. R., CARLIN, J. B., ROBERTSON, C. F., HOPPER, J. L., DALTON, M. F., HOLST, D. P., CHOI, K., & GILES, G. G.
- Affiliations
- The University of Melbourne (AU)
- Royal Children's Hospital (AU)
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 1996
- Volume
- 25
- Issue
- 3
- Pages
- 609-616
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- OpenAlex
- W2110293081
- Cited by
- 446
- References
- 29
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 3 · 2023: 7 · 2022: 14 · 2021: 8 · 2020: 17 · 2019: 10 · 2018: 15 · 2017: 15 · 2016: 26 · 2015: 22 · 2014: 22 · 2013: 21 · 2012: 25
- FWCI
- 4.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- asthma diagnosis, questionnaire validity, ISAAC questionnaire, airway hyperresponsiveness, hypertonic saline challenge, physician diagnosis, diagnostic accuracy, asthma prevalence, children, adults, asthma definition, sensitivity and specificity, predictive value, asthma symptoms, Tasmania, Australia
- MeSH terms
- Adolescent, Adult, Asthma, Australia, Clinical Competence, Female, Humans, Male, Predictive Value of Tests, Surveys and Questionnaires, Sensitivity and Specificity, Reproducibility of Results, Bronchial Hyperreactivity
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