Screening for asthma-like symptoms and acute care utilization can be used to identify children in the community who may be at risk for undiagnosed asthma

Asthma prevalence is increasing but it is difficult to identify children at risk for asthma, thus many at-risk children remain undiagnosed. We hypothesized that a screening tool that included a history of asthma-like symptoms and acute care visits to a clinic, emergency department, or hospital for respiratory symptoms within the previous year would be useful to identify children with undiagnosed asthma. Method: After local IRB approval, we recruited 103 children from a local church and a school. Parents responded to a questionnaire about whether or not their children experienced four different asthma-like symptoms in the past year (wheezing, night time cough, exercise limitation, or prolonged colds lasting for ≥10 days) and acute care visits. Twenty of the children had been diagnosed with asthma by a physician. We compared their asthma-like symptoms with 83 children who had not been diagnosed with asthma. Results: The prevalence or pre-test probability that a child in this community may have asthma was 19.4%. The combination of night time cough and any acute care visit was reported by 65% (n=13) of children with asthma and 14.6% (n=12) of children without a diagnosis of asthma. Based on a likelihood ratio of 4.4, the post-test probability that children in the community who experience exercise limitations and any type of acute care may have asthma increased to 52%. The odds that a child with this combination had asthma were 10.8 times greater than children who experienced other symptom/acute care combinations. Conclusion: This brief screening tool can be useful to identify children with potentially undiagnosed asthma.