Asthma after childhood pneumonia: six year follow up study

Objective To establish the long term cum cumulative prevalence of asthma in children admitted to hospital with pneumonia and to examine the hypothesis that some children admitted to hospital with pneumonia may be presenting w ith undiagnosed asthma Design Prospective study of a cohort of children previously admitted to hos pital with pneumonia, followed up by postal questionnaires to their general practitioners and the children or their parents. Setting General practices in southwest England. Participants 78 children admitted to the Royal Devon and Exeter Hospital be tween 1989 and 1991 with a diagnosis of pneumonia confirmed on independent review of x ray films. Main outcome measures Any diagnosis of asthma, use of any treatment for ast hma, and asthma symptom scores. Results On the basis of a 100% response rate from general practitioners and 86% from patients or parents, the cumulative prevalence of asthma was 45%. A diagnosis of asthma was associated with a family history of asthma (odds ratio 11.23; 95% confidence interval 2.57 to 56.36; P = 0.0002). Mean symp tom scores were higher for all children with asthma (mean score 2.4; chi(2) = 14.88; P = 0.0001) and for children with asthma not being treated (mean 1.4; chi(2) = 6.2; P = 0.01) than for those without asthma (mean 0.2). Conclusions A considerable proportion of children presenting to a district general hospital with pneumonia either already have unrecognised asthma or subsequently develop asthma. The high cumulative prevalence of asthma sugge sts that careful follow up of such children is worth while. Asthma is under treated in these children; a structured symptom questionnaire may help to i dentify and reduce morbidity due to undertreatment.