Protocol - Personal and Family History of Respiratory Symptoms/Diseases - Child
- Cigarette Smoking Status - Adolescent
- Cigarette Smoking Status - Adult
- Current Marital Status
- Ethnicity and Race
- Gender Identity
- Height - Knee Height
- Medication Inventory
- Occupation/Occupational History
Description
Age-specific questions are asked in this protocol to two different age ranges of children. For children ages 13 and 14, questions are asked directly to the child. For children 6 or 7 years old, questions are asked of the parents.
Specific Instructions
The parental questionnaire was used in a study of parents of children aged 6 to 7 years. The Respiratory Working Group deems the questionnaire appropriate to use with parents of children under the age of 14.
Availability
Protocol
Questionnaire for 13 and 14 year olds
1. Have you ever had wheezing or whistling in the chest at any time in the past?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 6.
2. Have you had wheezing or whistling in the chest in the last 12 months?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 6.
3. How many attacks of wheezing have you had in the last 12 months?
[ ] None
[ ] 1 to 3
[ ] 4 to 12
[ ] More than 12
4. In the last 12 months, how often, on average, has your sleep been disturbed due to wheezing?
[ ] Never woken with wheezing
[ ] Less than one night per week
[ ] One or more nights per week
5. In the last 12 months, has wheezing ever been severe enough to limit your speech to only one or two words at a time between breaths?
[ ] Yes
[ ] No
6. Have you ever had asthma?
[ ] Yes
[ ] No
7. In the last 12 months, has your chest sounded wheezy during or after exercise?
[ ] Yes
[ ] No
8. In the last 12 months, have you had a dry cough at night, apart from a cough associated with a cold or chest infection?
[ ] Yes
[ ] No
All questions are about problems which occur when you DO NOT have a cold or the flu.
9. Have you ever had a problem with sneezing, or a runny or blocked nose, when you DID NOT have a cold or the flu?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 14.
10. In the past 12 months, have you had a problem with sneezing, or a runny or blocked nose, when you DID NOT have a cold or the flu?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 14.
11. In the past 12 months, has this nose problem been accompanied by itchy or watery eyes?
[ ] Yes
[ ] No
12. In which of the past 12 months did this nose problem occur? (Please tick any which apply.)
[ ] January
[ ] February
[ ] March
[ ] April
[ ] May
[ ] June
[ ] July
[ ] August
[ ] September
[ ] October
[ ] November
[ ] December
13. In the past 12 months, how much did this nose problem interfere with your daily activities?
[ ] Not at all
[ ] A little
[ ] A moderate amount
[ ] A lot
14. Have you ever had hay fever?
[ ] Yes
[ ] No
15. Have you ever had an itchy rash which was coming and going for at least six months?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 20.
16. Have you had this itchy rash at any time in the last 12 months?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 20.
17. Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, in front of the ankles, under the buttocks, or around the neck, ears, or eyes?
[ ] Yes
[ ] No
18. Has this rash cleared completely at any time during the last 12 months?
[ ] Yes
[ ] No
19. In the last 12 months, how often, on average, have you been kept awake at night by this itchy rash?
[ ] Never in the last 12 months
[ ] Less than one night per week
[ ] One or more nights per week
20. Have you ever had eczema?
[ ] Yes
[ ] No
Questionnaire for 6 and 7 year olds
21. Has your child ever had wheezing or whistling in the chest at any time in the past?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 26.
22. Has your child had wheezing or whistling in the chest in the last 12 months?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 26.
23. How many attacks of wheezing has your child had in the last 12 months?
[ ] None
[ ] 1 to 3
[ ] 4 to 12
[ ] More than 12
24. In the last 12 months, how often, on average, has your child’s sleep been disturbed due to wheezing?
[ ] Never woken with wheezing
[ ] Less than one night per week
[ ] One or more nights per week
25. In the last 12 months, has wheezing ever been severe enough to limit your child’s speech to only one or two words at a time between breaths?
[ ] Yes
[ ] No
26. Has your child ever had asthma?
[ ] Yes
[ ] No
27. In the last 12 months, has your child’s chest sounded wheezy during or after exercise?
[ ] Yes
[ ] No
28. In the last 12 months, has your child had a dry cough at night, apart from a cough associated with a cold or chest infection?
[ ] Yes
[ ] No
29. Has your child ever had a problem with sneezing, or a runny or blocked nose, when he/she DID NOT have a cold or the flu?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 34.
30. In the past 12 months, has your child had a problem with sneezing, or a runny or blocked nose, when he/she DID NOT have a cold or the flu?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 34.
31. In the past 12 months, has this nose problem been accompanied by itchy, watery eyes?
[ ] Yes
[ ] No
32. In which of the past 12 months did this nose problem occur? (Please tick any which apply)
[ ] January
[ ] February
[ ] March
[ ] April
[ ] May
[ ] June
[ ] July
[ ] August
[ ] September
[ ] October
[ ] November
[ ] December
33. In the past 12 months, how much did this nose problem interfere with your child’s daily activities?
[ ] Not at all
[ ] A little
[ ] A moderate amount
[ ] A lot
34. Has your child ever had hay fever?
[ ] Yes
[ ] No
35. Has your child ever had an itchy rash that was coming and going for at least 6 months?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 40.
36. Has your child had this itchy rash at any time in the last 12 months?
[ ] Yes
[ ] No
IF YOU HAVE ANSWERED "NO," PLEASE SKIP TO QUESTION 40.
37. Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, in front of the ankles, under the buttocks, or around the neck, ears, or eyes?
[ ] Yes
[ ] No
38. At what age did this itchy rash first occur?
[ ] Under 2 years
[ ] Age 2-4 years
[ ] Age 5 or more
39. Has this rash cleared completely at any time during the last 12 months?
[ ] Yes
[ ] No
40. In the last 12 months, how often, on average, has your child been kept awake at night by this itchy rash?
[ ] Never in the last 12 months
[ ] Less than one night per week
[ ] One or more nights per week
41. Has your child ever had eczema?
[ ] Yes
[ ] No
Personnel and Training Required
None
Equipment Needs
None
Requirements
Requirement Category | Required |
---|---|
Major equipment | No |
Specialized training | No |
Specialized requirements for biospecimen collection | No |
Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Self-administered or interviewer-administered questionnaire
Lifestage
Child, Adolescent
Participants
Children aged 13 to 14 years
Parents of children aged 6 to 7 years
Selection Rationale
The International Study of Asthma and Allergies in Childhood (ISAAC) was founded to maximize the value of epidemiological research into asthma and allergic disease by establishing a standardized methodology and facilitating international collaboration.
Language
Chinese, English
Standards
Standard | Name | ID | Source |
---|---|---|---|
Logical Observation Identifiers Names and Codes (LOINC) | Resp fam hx resp sympt child proto | 62626-7 | LOINC |
Human Phenotype Ontology | Functional respiratory abnormality | HP:0002795 | HPO |
caDSR Form | PhenX PX090902 - Personal And Family History Of Respiratory Sym Child | 5968912 | caDSR Form |
Derived Variables
None
Process and Review
Expert Review Panel #6 (ERP 6) reviewed the measures in the Respiratory domain.
Guidance from ERP 6 includes:
• No significant changes to measure
Back-compatible: no changes to Data Dictionary
Protocol Name from Source
International Study of Asthma and Allergies in Childhood (ISAAC) Manual
Source
The International Study of Asthma and Allergies in Childhood (ISAAC) Manual. December 1993, 2nd Edition. Module 1.1, questions 1-8 (questions 1-8 and 21-28); Module 1.2, questions 1-6 (questions 9-14 and 29-34); and Module 1.3, questions 1-7 (questions 15-20 and 35-41).
General References
Beasley, R. (1998). Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The Lancet, 351(9111), 1225-1232.
Protocol ID
90902
Variables
Export VariablesVariable Name | Variable ID | Variable Description | dbGaP Mapping | |
---|---|---|---|---|
PX090902_Asthma_Ever_13 | ||||
PX090902060000 | Have you ever had asthma? | Variable Mapping | ||
PX090902_Asthma_Ever_6 | ||||
PX090902260000 | Has your child ever had asthma? | N/A | ||
PX090902_Dry_Cough_Night_12_Months_13 | ||||
PX090902080000 | In the last 12 months, have you had a dry more | N/A | ||
PX090902_Dry_Cough_Night_12_Months_6 | ||||
PX090902280000 | In the last 12 months, has your child had a more | N/A | ||
PX090902_Eczema_Ever_13 | ||||
PX090902200000 | Have you ever had eczema? | Variable Mapping | ||
PX090902_Eczema_Ever_6 | ||||
PX090902410000 | Has your child ever had eczema? | Variable Mapping | ||
PX090902_Hay_Fever_Ever_13 | ||||
PX090902140000 | Have you ever had hay fever? | Variable Mapping | ||
PX090902_Hay_Fever_Ever_6 | ||||
PX090902340000 | Has your child ever had hay fever? | N/A | ||
PX090902_Itchy_Rash_12_Months_13 | ||||
PX090902160000 | Have you had this itchy rash at any time in more | N/A | ||
PX090902_Itchy_Rash_12_Months_6 | ||||
PX090902360000 | Has your child had this itchy rash at any more | N/A | ||
PX090902_Itchy_Rash_Affected_Sites_Places_13 | ||||
PX090902170000 | Has this itchy rash at any time affected any more | N/A | ||
PX090902_Itchy_Rash_Affected_Sites_Places_6 | ||||
PX090902370000 | Has this itchy rash at any time affected any more | N/A | ||
PX090902_Itchy_Rash_Cleared_Completely_13 | ||||
PX090902180000 | Has this rash cleared completely at any time more | N/A | ||
PX090902_Itchy_Rash_Cleared_Completely_6 | ||||
PX090902390000 | Has this rash cleared completely at any time more | N/A | ||
PX090902_Itchy_Rash_Ever_13 | ||||
PX090902150000 | Have you ever had an itchy rash which was more | N/A | ||
PX090902_Itchy_Rash_Ever_6 | ||||
PX090902350000 | Has your child ever had an itchy rash that more | N/A | ||
PX090902_Itchy_Rash_First_Age_6 | ||||
PX090902380000 | At what age did this itchy rash first occur? | N/A | ||
PX090902_Itchy_Rash_Often_Awake_Night_13 | ||||
PX090902190000 | In the last 12 months, how often, on more | N/A | ||
PX090902_Itchy_Rash_Often_Awake_Night_6 | ||||
PX090902400000 | In the last 12 months, how often, on more | N/A | ||
PX090902_Nose_Interfere_Activities_12_Months_13 | ||||
PX090902130000 | In the past 12 months, how much did this more | N/A | ||
PX090902_Nose_Interfere_Activities_12_Months_6 | ||||
PX090902330000 | In the past 12 months, how much did this more | N/A | ||
PX090902_Nose_Itchy_Eyes_12_Months_13 | ||||
PX090902110000 | In the past 12 months, has this nose problem more | N/A | ||
PX090902_Nose_Itchy_Eyes_12_Months_6 | ||||
PX090902310000 | In the past 12 months, has this nose problem more | N/A | ||
PX090902_Sneezing_Runny_Nose_12_Months_13 | ||||
PX090902100000 | In the past 12 months, have you had a more | N/A | ||
PX090902_Sneezing_Runny_Nose_12_Months_6 | ||||
PX090902300000 | In the past 12 months, has your child had a more | N/A | ||
PX090902_Sneezing_Runny_Nose_Ever_13 | ||||
PX090902090000 | Have you ever had a problem with sneezing, more | Variable Mapping | ||
PX090902_Sneezing_Runny_Nose_Ever_6 | ||||
PX090902290000 | Has your child ever had a problem with more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_April | ||||
PX090902120400 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_August | ||||
PX090902120800 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_December | ||||
PX090902121200 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_February | ||||
PX090902120200 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_January | ||||
PX090902120100 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_July | ||||
PX090902120700 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_June | ||||
PX090902120600 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_March | ||||
PX090902120300 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_May | ||||
PX090902120500 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_November | ||||
PX090902121100 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_October | ||||
PX090902121000 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_13_September | ||||
PX090902120900 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_April | ||||
PX090902320400 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_August | ||||
PX090902320800 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_December | ||||
PX090902321200 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_February | ||||
PX090902320200 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_January | ||||
PX090902320100 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_July | ||||
PX090902320700 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_June | ||||
PX090902320600 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_March | ||||
PX090902320300 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_May | ||||
PX090902320500 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_November | ||||
PX090902321100 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_October | ||||
PX090902321000 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Sneezing_Runny_Nose_Occurrence_Months_6_September | ||||
PX090902320900 | In which of the past 12 months did this nose more | N/A | ||
PX090902_Wheezing_Attack_Times_12_Months_13 | ||||
PX090902030000 | How many attacks of wheezing have you had in more | Variable Mapping | ||
PX090902_Wheezing_Attack_Times_12_Months_6 | ||||
PX090902230000 | How many attacks of wheezing has your child more | Variable Mapping | ||
PX090902_Wheezing_Limit_Speech_12_Months_13 | ||||
PX090902050000 | In the last 12 months, has wheezing ever more | N/A | ||
PX090902_Wheezing_Limit_Speech_12_Months_6 | ||||
PX090902250000 | In the last 12 months, has wheezing ever more | N/A | ||
PX090902_Wheezing_Sleep_Disturbed_12_Months_13 | ||||
PX090902040000 | In the last 12 months, how often, on more | N/A | ||
PX090902_Wheezing_Sleep_Disturbed_12_Months_6 | ||||
PX090902240000 | In the last 12 months, how often, on more | N/A | ||
PX090902_Wheezing_Whistling_Chest_12_Months_13 | ||||
PX090902020000 | Have you had wheezing or whistling in the more | Variable Mapping | ||
PX090902_Wheezing_Whistling_Chest_12_Months_6 | ||||
PX090902220000 | Has your child had wheezing or whistling in more | N/A | ||
PX090902_Wheezing_Whistling_Chest_Ever_13 | ||||
PX090902010000 | Have you ever had wheezing or whistling in more | Variable Mapping | ||
PX090902_Wheezing_Whistling_Chest_Ever_6 | ||||
PX090902210000 | Has your child ever had wheezing or more | Variable Mapping | ||
PX090902_Wheezy_Chest_Exercise_12_Months_13 | ||||
PX090902070000 | In the last 12 months, has your chest more | Variable Mapping | ||
PX090902_Wheezy_Chest_Exercise_12_Months_6 | ||||
PX090902270000 | In the last 12 months, has your child's more | N/A |
Measure Name
Personal and Family History of Respiratory Symptoms/Diseases
Release Date
January 29, 2010
Definition
This measure assesses the history of respiratory symptoms (i.e., cough, phlegm, shortness of breath, wheezing) and respiratory diseases.
Purpose
Personal and family histories of respiratory symptoms and diseases are important to assess for overall health and quality of life. Standardized approaches to assess respiratory symptoms and diseases are required to define many respiratory phenotypes.
Keywords
Respiratory, lung, cough, phlegm, wheezing, Family History, smoking, International Study of Asthma and Allergies in Childhood, ISAAC
Measure Protocols
Protocol ID | Protocol Name |
---|---|
90901 | Personal and Family History of Respiratory Symptoms/Diseases - Adult |
90902 | Personal and Family History of Respiratory Symptoms/Diseases - Child |
Publications
There are no publications listed for this protocol.