STABILITY OF RESPIRATORY SYMPTOMS IN UNLABELED WHEEZY ILLNESS AND NOCTURNAL COUGH

Objective-To assess the natural history of respiratory symptoms not la belled as asthma in primary schoolchildren. Design-Repeat questionnair e survey of subgroups identified from a previous questionnaire survey after a two year delay. Subjects-The original population of 5321 Sheff ield children aged 8-9 years yielded 4406 completed questionnaires in 1991 (82.8%). After excluding children with a label of asthma, there w ere 370 children with current wheeze, 129 children with frequent noctu rnal cough, and a random Sample of 222 children with minor cough sympt oms and 124 asymptomatic children. Results-Response rates in the four groups were 233 (63.0%), 77 (59.7%), 160 (72.1%), and 90 (72.6%) respe ctively. Of those who initially wheezed, 114 (48.9%) had stopped wheez ing and 42 (18.0%) had been labelled as having asthma. Those with more frequent wheezing episodes (p < 0.02) and a personal history of hay f ever (p < 0.01) in 1991 were more likely to retain their wheezy sympto ms. In the children with frequent nocturnal cough in 1991, 20.1% had d eveloped wheezing, 42.9% had a reduced frequency of nocturnal coughing , and 14.2% had stopped coughing altogether two years later. One sixth had been labelled as having asthma. Children with nocturnal cough wer e more likely to develop wheezing if they: had a family history of ato py (p = 0.02). Only 3.8% and 3.3% of those with minimal cough and no s ymptoms respectively in 1991 had developed wheeze by 1993 (1.9% and 1. 0% labelled as asthma). Conclusions-Most unlabelled recurrent respirat ory symptoms in 8-10 year olds tend to improve. Unlabelled children wh o have persistent symptoms have other features such as frequent wheezi ng attacks and a family or personal history of atopy. If a screening q uestionnaire were to be used to identify Such children, a combination of questions should be employed.