Correspondence

Throat Clearing — A Novel Asthma Symptom in Children

N Engl J Med 2003; 348:1502-1503April 10, 2003

Article

To the Editor:

The diagnosis of asthma in children is based largely on symptoms and physical findings, since tests of lung function are often difficult to obtain. Although wheeze and cough are commonly recognized as symptoms of asthma, other asthma symptoms may not be recognized. We report here on throat clearing as a lone, and previously underrecognized, symptom of asthma.

We distributed 2690 questionnaires, based on those used in the International Study of Asthma and Allergies in Childhood,1 to parents of children attending 70 day-care centers in 2 cities and 32 villages in Crete, Greece. The questionnaire was modified, on the basis of our experience, to include an additional question: “Does your child have a habit of clearing his or her throat often?”

Parents of 2609 children (97.0 percent) returned completed questionnaires. The mean (±SD) age of the children was 4.3±1.2 years. The prevalence of asthma diagnosed by a physician within the previous 12 months was 17.9 percent, the prevalence of asthma diagnosed more than 12 months previously was 23.7 percent, the prevalence of rhinitis was 21.6 percent, the prevalence of eczema was 8.6 percent, and the prevalence of conjunctivitis was 4.9 percent. Prevalences of parent-reported symptoms of asthma are shown in Table 1Table 1Prevalence of Parent-Reported Asthma-Related Symptoms..

Among the 106 children (71 boys and 35 girls) whose parents noted throat clearing, 61 reported no current or past asthma or other symptoms of asthma. Because of a clinical suspicion of asthma in these children, lung-function tests were performed in the 30 children who were old enough to cooperate; the average forced expiratory volume in one second (FEV₁) was 93.4±13.2 percent of the predicted value. Treatment of these children with standard asthma medications (inhaled corticosteroids once a day) led to resolution of throat clearing in all of them and an improvement in mean lung function; the mean FEV₁ after treatment was 119.4±18.0 percent of the predicted value (P<0.001 for the comparison with the FEV₁ before treatment). These changes are consistent with the diagnosis of clinically unrecognized asthma.

Our data demonstrate that throat clearing, in the absence of any other recognized symptom of asthma, can be a clinical indicator of the presence of asthma. In our cohort of children in day care, the overall prevalence of asthma was similar to that reported by others2,3 but higher than that previously reported in Greece.4 However, if we had used only the standard diagnostic questions, we would have missed 30 cases of asthma in this cohort that were identified solely on the basis of throat clearing as a novel symptom of asthma. When evaluating children for possible respiratory disorders, clinicians should consider this additional question as part of the standard history taking.

Eva C. Mantzouranis, M.D.
Sosipatros A. Boikos, M.D.
Gregory Chlouverakis, Ph.D.
University of Crete, Heraklion, Crete 71110, Greece
mantzourani@med.uoc.gr

4 References

1
Asher MI, Keil U, Anderson HR, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J 1995;8:483-491
CrossRef | Web of Science | Medline

2
Shamssain MH, Shamsian N. Prevalence and severity of asthma, rhinitis, and atopic eczema: the north east study. Arch Dis Child 1999;81:313-317
CrossRef | Web of Science | Medline

3
Kuehni CE, Davis A, Brooke AM, Silverman M. Are all wheezing disorders in very young (preschool) children increasing in prevalence? Lancet 2001;357:1821-1825[Erratum, Lancet 2001;358:846.]
CrossRef | Web of Science | Medline

4
Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998;12:315-335
CrossRef | Web of Science | Medline

Citing Articles (1)