Methods: 482 consecutively referred children aged 5-14 (mean 7.9) years, 99 girls (21%) and 383 boys (79%) with a primary care doctor's referral diagnosis of difficult-to-treat asthma were included from the prospective Asthma in a Secondary Pediatric Referral Centre Study (ASP 2002) in the present survey. At referral and during a 6 months evaluation period patient characteristics, history, symptoms, signs and results of type 1 allergy tests, spirometry, post bronchial beta-2 agonist dilation tests, 4-weeks daily measurement of peak flow rates, corticosteroid reversibility trials and exercise challenge tests were entered into a pre-defined electronic form. The secondary referral centre (SRC) diagnosis of asthma was based on these data.
Results: A diagnosis of asthma was confirmed in 200 (41%), whereas it could not be confirmed in 282 (59%) of the children. Allergic rhinoconjunctivitis was diagnosed in 96 (48%) in the confirmed group, in 87 (31%) in the not confirmed group. A variety of differential diagnoses was made in the children in whom asthma was not confirmed.
Conclusions: In more than half of school age children with a primary care doctor´s diagnosis of difficult-to-treat asthma referred to a secondary paediatric referral centre the diagnosis may not be confirmed. Sensitivity and specificity of the diagnosis of asthma in schoolchildren made in primary care settings need further improvement.