Validation of the Brief Pediatric Asthma Screen

A Mixed-methods Study Examining Inhaler Carry and Use among Children at School

Objective: Asthma self-management depends partly on access to inhalers; for children, this includes independent inhaler carry and use at school ("self-carry"). Although laws and policies support self-carry, little is known about practices within schools. This study aimed to identify factors associated with inhaler self-carry among children and examine barriers and facilitators to self-carry.Methods: This mixed-methods observational study included child-parent dyads and nurses from four Chicago schools. Children and parents answered questions about asthma care and morbidity, confidence in self-carry skills, and facilitators and barriers to self-carry. Nurses reported asthma documentation on file and their confidence in children's self-carry skills. Analysis utilized logistic regression. Thematic analysis was performed for open-ended questions.Results: Of 65 children enrolled (mean = 10.66 years), 45 (69.2%) reported having quick-relief medication at school, primarily inhalers, and 35 (53.8%) reported self-carry. Inhaler self-carry was associated with controller medication use and parent confidence in child's self-carry skills. Children and parents identified several facilitators to self-carry: child's asthma knowledge, inhaler characteristics, and need for easy inhaler access. Barriers included child's limited understanding of asthma and inhalers, perception that inhaler is not needed, and limited inhaler access. Children also emphasized social relationships as facilitators and barriers, while parents described children's responsibility as a facilitator and inconsistent policy implementation as a barrier.Conclusions: Efforts to improve inhaler self-carry at school should focus on educating children about asthma and inhaler use, creating supportive environments for self-carry among peers and teachers, and fostering consistent implementation and communication about asthma policy among schools and families.

A qualitative study of parent perspectives on barriers, facilitators and expectations for school asthma care among urban, African-American children

Objectives: Minority children experience the disproportionate burden of asthma and its consequences. Studies suggest ethnic groups may experience asthma differently with varied perceptions and expectations among parents of African-American and Latino children. Because parents coordinate asthma care with the school, where children spend a significant amount of their day, this study's goal was to determine parents' perspectives on school asthma management. Methods: Focus groups were conducted with parents of children with asthma at four urban schools whose student population is predominantly African-American. A semi-structured guide was utilized focusing on barriers, facilitators and expectations for asthma care at school. Grounded theory principles were applied in this study. Results: Twenty-two parents (91% females) representing 13 elementary and 10 middle school children with asthma (61% boys) participated in four focus groups. Most children (87%) had persistent asthma. The identified barriers to effective school-based asthma care included limited awareness of children with asthma by teachers/staff, communication issues (e.g. school/parent, within school), inadequate education and lack of management plans or systems in place. In contrast, the identified facilitators included steps that fostered education, communication and awareness, as supported by management plans and parent initiative. Parents described their expectations for increased communication and education about asthma, better systems for identifying children with asthma, and a trained asthma point person for school-based asthma care. Conclusions: Parents of children with asthma identified important barriers, facilitators and expectations that must be considered to advance school asthma management. Improved school-based asthma care could lead to better health and academic outcomes.

An Examination of the Association of Multiple Acculturation Measures with Asthma Status Among Elementary School Students in El Paso, Texas

Some researchers posit that the lower prevalence of asthma among those of Mexican descent may result from an under-diagnosis and recommend a critical appraisal of factors related to race/ethnicity, like acculturation, and its influence on asthma status. Survey data were analyzed using multinomial logistic regression to examine the association of child's asthma status (no wheezing/no asthma symptoms, possible undiagnosed and diagnosed asthma) with measures of acculturation among Hispanic students (n = 1095). In this population, the prevalence of diagnosed asthma (15%) was higher than both national (7.6%) and state (6.8%) averages for Hispanic children in 2012. While bivariate analyses showed significant associations for asthma status and measures of acculturation, multivariate analyses did not. There is an underestimated burden of illness among Hispanic children in El Paso County. More research on the suitability of acculturation constructs is needed to delineate what they actually measure and how acculturation influences asthma status.

Validation of a questionnaire for asthma case identification in pre-schools in Latin America

BACKGROUND AND OBJECTIVE

We recently developed and validated a screening questionnaire for determining which school-aged children may need further investigation to diagnose and manage asthma. In the present study we sought to extend this to pre-school aged children.

METHODS

Questions from the school-aged questionnaire and literature on pre-school asthma were used to inform a focus group of parents with pre-school-aged children with asthma to develop a screening questionnaire. Parents of children attending 6 randomly selected kindergartens in Trelew, Argentina (n = 639) were invited to respond to the questionnaire. A reliability test-retest was undertaken in 187 randomly selected parents who completed the same questionnaire twice within 2-5 weeks. Clinical assessment included a standardized history and physical examination, spirometry before and after a β-agonist inhaler, and chest X-ray. Asthma was diagnosed by the pulmonologist.

RESULTS

Completed surveys were returned for 620 children, 607 of whom underwent clinical evaluation. The mean age was 4.21 years (range of 3.01-5.50) and included 82.5% white and 49.4% male children. Asthma was diagnosed in 103 (17.0%) children); 72 (69.9%) of these children did not have a previous diagnosis of asthma. The specificity, sensitivity, positive predictive value and negative predictive value of the questionnaire were 93.2%, 86.1%, 57.8% and 98.4%, respectively.

CONCLUSIONS

We have demonstrated the utility of a screening questionnaire for identifying pre-school-aged children who may benefit from further assessment for asthma.

Asthma screening of inner city and urban elementary school-aged children

OBJECTIVE

Currently, in the United States there is a lack of a standardized method to effectively screen school children with undiagnosed or poorly controlled asthma. The purpose of this proof-of-concept study was to assess the use of the American College of Allergy, Asthma, and Immunology's (ACAAI) Asthma Screening Questionnaire to identify elementary school-age children at risk for asthma (undiagnosed) or poorly controlled asthma.

METHODS

Children in grades 3-5 from one urban and two suburban schools completed ACAAI's 14 question asthma screening questionnaire and had their peak expiratory flow (PEF) measured. Children were considered to have a positive asthma screen and be at risk for having undiagnosed or poorly controlled asthma if they answered 'yes' to more than three questions. Children were referred to a physician if they had a positive asthma screen, a previous history of asthma, or a low PEF.

RESULTS

Of the 86 participants, 52 were identified as being at risk for asthma. The number was higher among children attending an urban versus suburban school (p = 0.04). The sensitivity and specificity of the screening questionnaire for identifying asthma risk were 90% and 66%, respectively, when the number of 'yes' responses for a positive screen was increased from three to five of 14 questions.

CONCLUSIONS

The ACAAI's Asthma Screening Questionnaire identified 52 children at risk for undiagnosed or poorly controlled asthma. Our findings support the need to validate this questionnaire to be used in conjunction with PEFR for identifying elementary school children at risk for asthma.

Improving asthma management among African-American children via a community health worker model: findings from a Chicago-based pilot intervention

OBJECTIVES

Asthma affects 25-30% of children living in certain disadvantaged Chicago neighborhoods, a rate twice the national prevalence (13%). Children living in poor, minority communities tend to rely heavily on the emergency department (ED) for asthma care and are unlikely to be properly medicated or educated on asthma self-management. A pilot project implemented and evaluated a community health worker (CHW) model for its effectiveness in reducing asthma morbidity and improving the quality of life among African-American children living in disadvantaged Chicago neighborhoods.

METHODS

Trained CHWs from targeted communities provided individualized asthma education during three to four home visits over 6 months. The CHWs also served as liaisons between families and the medical system. Seventy children were enrolled into the pilot phase between 15 November 2004 and 15 July 2005, of which 96% were insured by Medicaid and 54% lived with a smoker. Prior to starting, the study was approved by an institutional review board. Data on 50 children (71.4%) who completed the entire 12-month evaluation phase were analyzed using a before and after study design.

RESULTS

Findings indicate improved asthma control. Specifically, symptom frequency was reduced by 35% and urgent health resource utilization by 75% between the pre- and post-intervention periods. Parental quality of life also improved by a level that was both clinically and statistically significant. Other important outcomes included improved asthma-related knowledge, decreased exposure to asthma triggers, and improved medical management. The intervention was also shown to be cost-effective, resulting in an estimated $5.58 saved per dollar spent on the intervention.

CONCLUSIONS

Findings suggest that individualized asthma education provided by a trained, culturally competent CHW is effective in improving asthma management among poorly controlled, inner-city children. Further studies are needed to affirm the findings and assess the model's generalizability.

Validation of a school-based written questionnaire for asthma case identification in Argentina

Recognition of asthma in community-based surveys can be problematic. We sought to develop and validate questionnaires that could identify elementary school-aged children likely to have asthma or who had poorly-controlled asthma. Questionnaires for parents (PQ) and students (SQ) to complete were developed using guidance on question wording from a focus group consisting of children with asthma and their parents. The gold standard for this study was a pulmonologist determination of asthma and this was used to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each question and for combinations of questions. Questionnaires were distributed to 830 children attending elementary schools in Trelew, Argentina and 96% were returned. Test-retest reliability was determined in 221 randomly selected parents and children and very good levels of agreement were seen for individual questions. Asthma was diagnosed in 92 students. Overall, the PQ was able to detect asthma better than the SQ. Optimal diagnostic ability came by combining questions from the PQ and SQ. Not surprisingly, these questionnaires had a better NPV than PPV and can be used to determine which children require further evaluation.

Lessons for primary prevention of asthma: foreign-born children have less association of SES and pests with asthma diagnosis

There are no proven interventions for primary prevention of asthma. As asthma prevalence varies globally, comparing asthma in native and foreign-born children might provide insights. We pooled data from five cross sectional asthma surveys (N = 962). Place of birth was associated with asthma (OR = 3.4, P < 0.001). In children not born in the US, lower socio-economic status had no significant effect on asthma (OR = 0.71, P = 0.53), while for children born in the US, the effect was significant (OR = 2.1, P = 0.001). The odds ratio for exposure to household pests was significant (OR = 1.6, P < 0.008) for children born in the US but was non-significant for children born outside the US (OR = 0.29, P = 0.11). Our findings are consistent with foreign-born children experiencing protective factors or US born children experiencing detrimental environmental exposures.

Posttussive emesis as a symptom of asthma in children

BACKGROUND

Emesis can be triggered by cough in children, and cough is a common symptom of asthma.

OBJECTIVE

To explore the association between posttussive emesis and asthma in the pediatric population.

METHODS

A questionnaire was distributed to parents of children between the ages of 2 and 17 years in the pediatric and allergy-immunology clinics at our institution from August 16 through November 3, 2008. Prevalence of posttussive emesis was determined and compared among children with physician-diagnosed asthma, children with no evidence of asthma, and those not formally diagnosed as having asthma but with surrogate markers suggestive of asthma. The predictive value of posttussive emesis was compared with those of known markers of asthma. The prevalence of gastroesophageal reflux and pertussis was evaluated because these conditions might also cause posttussive emesis.

RESULTS

The prevalence of posttussive emesis was 33% in our study population of 500 children. Among those with physician-diagnosed asthma (n = 122), 56% reported a history of posttussive emesis. For patients not formally diagnosed as having asthma but with surrogate markers suggestive of asthma (n = 62), 71% had a history of posttussive emesis. Both of these were significantly higher than in those with no evidence of asthma (n = 316), in whom 16% reported a history of posttussive emesis (P < .0005). Children with posttussive emesis were significantly more likely to have asthma than those without posttussive emesis (odds ratio, 7.9; 95% confidence interval, 5.2-12). Neither pertussis nor gastroesophageal reflux accounted for the degree of posttussive emesis reported.

CONCLUSIONS

Posttussive emesis is more common among children with asthma than among nonasthmatic children. In children with cough and a history of posttussive emesis, asthma should be strongly considered in the differential diagnosis.

The healthy learner model for student chronic condition management--part II: the asthma initiative

The Healthy Learner Asthma Initiative (HLAI) was designed as a comprehensive, school-community initiative to improve asthma management and produce healthy learners. National asthma guidelines were translated into components of asthma management in the school setting that defined performance expectations and lead to greater quality and consistency of asthma care. The HLAI incorporated evidence-based practice and introduced the role of the asthma resource nurse. Leadership, capacity building, and strong partnerships among school nurses, students, families, and health care providers were essential to the implementation and sustainability of the HLAI. Professional school nursing and evaluation were defined as key requisites to a successful initiative. Evaluation results indicated positive effects on nursing practice, fewer asthma visits to the health office, and better attendance among students who received asthma care in the school health office. The HLAI provided the basis for development of the Healthy Learner Model for Student Chronic Condition Management.

Identifying preschool children with asthma in Orange County

Airway changes related to childhood asthma occur early in the disease process. This pilot study focuses on the validation of the Breathmobile Case Identification Survey (BCIS) in preschool-age children in Orange County, CA. Fifty-two children from low-income Spanish-speaking families participated in the study. Thirteen children were identified as possibly having asthma from the survey results compared with 20 children diagnosed by an asthma specialist. We found that the complete seven-question survey had a sensitivity of 0.65 and a specificity of 0.94. An abbreviated three-question version had a sensitivity of 0.70 and a specificity of 0.84. Our data suggest that the abbreviated BCIS, which is simple and easily analyzed, may be a useful tool in identifying young children who are at risk for asthma and need further evaluation and appropriate therapy.

Detection of undiagnosed and poorly controlled asthma in a hospital-based outpatient pediatric primary care clinic using a health risk assessment system

OBJECTIVE

To determine the rate of undiagnosed and poorly controlled asthma detected by a computerized health risk assessment (HRA) survey system in an urban pediatric hospital-based outpatient teaching clinic.

METHODS

A software-based HRA system uses survey answer patterns to identify children with (1) probable, (2) uncontrolled, and (3) moderate to severe asthma. Parents of patients > or = 2 years of age were asked by clinic staff to complete the touch screen computer survey before seeing their physician from August 2005 through July 2006.

RESULTS

The HRA survey predicted 26% (282/1,098) to have probable asthma. Of these, 51% (144/282) were controlled and the parents reported a previous diagnosis of asthma; 14% (40/282) were controlled and the parents did not report a previous diagnosis of asthma; 25% (71/282) were uncontrolled and the parents reported a previous diagnosis of asthma; and 10% (27/282) were uncontrolled and no previous diagnosis of asthma was reported by the parents. Among active cases completing the baseline version survey (N = 217), 68% reported emergency department (ED) visits / hospitalizations in the last 2 years (44% > or =2), while 59% reported missed school days during the previous year (23% > or =5 days). Impairment, as defined by the 2007 National Heart, Lung, and Blood Institute/National Asthma Education and Prevention Program (NHLBI/NAEPP) asthma guidelines, tended to be higher in patients without a previous diagnosis of asthma, per parental report, but this trend only achieved significance in two measures: daytime symptoms > or =2 days per week in the last 4 weeks (p = 0.028) and more than 5 missed school days in the past year (p = 0.001).

CONCLUSION

A previously validated HRA system can consistently identify a high rate of undiagnosed and poorly controlled asthma in an urban pediatric hospital-based teaching clinic. The utility of such a system would be to reduce missed opportunities for delivery of care and morbidity for the patients who currently have undiagnosed and/or uncontrolled asthma in the pediatric primary care outpatient setting.

Community-level data suggest that asthma prevalence varies between U.S. and foreign-born black subpopulations

For Mexican and Chinese immigrants it has been reported that foreign born children have a lower prevalence of asthma than U.S.-born children. Inner-city black populations have a high prevalence of asthma. However, despite growing populations of black immigrants, we are aware of no previous studies that have looked at the effect of nativity on their asthma prevalence. We report data collected from a convenience sample in the Dorchester neighborhood of Boston for black respondents. The survey was conducted by medical students and community residents using a community-based participatory research approach. For adult respondents (n = 290) there was a strong negative association between being born outside the United States and reporting asthma (OR = 0.39; p = 0.033) that was retained in our multivariate model. For children (n = 157, reported by their parents) there was also a strong association with being born outside the United States (p < 0.05 using chi(2) tabular analysis); however, there were no foreign-born children with asthma so an OR could not be calculated and this association could not be carried forward into multivariate analyses. For children, but not adults, there were also strong associations between asthma and environmental factors. These findings point to the need for further research into nativity and asthma in black U.S. populations. Future studies should seek to obtain a representative sample, gather more demographic data than we did and seek a larger sample of children. It makes sense to ask about nativity in asthma prevalence studies in order to distinguish these two apparently very different subpopulations.

Targeting improvements in asthma morbidity in Chicago: a 10-year retrospective of community action

Chicago has been described as "asthma ground zero" due to its disproportionately high rates of asthma-related hospitalization and mortality. Asthma prevalence rates in Chicago are higher for whites and African Americans than the national average. In an effort to address the asthma burden and disparities in Chicago, multiple initiatives throughout the city have been launched and continue due largely to the support of the Otho S.A. Sprague Memorial Institute. The purpose of this article is to describe the policy, advocacy, educational, surveillance, research, quality improvement, community, and consortia activities over the past 10 years and their impact on asthma morbidity and disparities in Chicago.

A Comparison of knowledge about asthma between Asians and non-Asians at two pediatric clinics

Little is known about the relative knowledge of asthma in recent immigrant Asian populations in the United States (US). To comparatively assess asthma knowledge for Asian and non-Asian populations, 333 parents and children were surveyed at two geographically close urban clinics that had a large percentage of Asian patients, most of whom were Chinese. The Asian respondents scored lower compared to the non-Asian respondents on 4 of the 6 knowledge questions (p < 0.001). Subcategories of non-Asians (white, African-American, Hispanic) were more similar to each other than they were to Asians. In multivariate analysis we found that SES (measured as parental occupation) and being Asian were independent predictors of less asthma knowledge. Having family members with asthma did not improve knowledge scores. A single focus group of Cantonese-speaking parents of asthmatic children suggested that a combination of cultural factors and lack of knowledge contribute to lower knowledge scores in this Asian population. Asthma education programs need to be developed, tailored to recent Asian immigrants and tested for efficacy.

Assessing the Perceived Stress Scale for African American adults with asthma and low literacy

The Perceived Stress Scale (PSS) is a widely used measure of stress that has not been validated in asthma patients. The psychometric properties of the PSS were explored using confirmatory factor analysis and item response theory. Study 1 involved 312 ambulatory care patients with asthma who completed the PSS during a routine visit. Study 2 involved 247 community-dwelling adults with asthma who completed the PSS as a part of a larger asthma study. Four items showed acceptable psychometric performance across ethnic groups and literacy. The short PSS is a rapid, valid measure of subjective stress in diverse asthma populations.

Parent-reported physician diagnosis is an important factor in asthma management: an elementary school survey

Parent surveys seem to provide sufficient information for asthma case selection. In this study, elementary school children were identified for an asthma education program through a screening questionnaire, followed by a comprehensive family survey. The data were analyzed by groups according to those with parent-reported physician diagnosis or no physician diagnosis. Those with an asthma diagnosis had less nighttime symptoms, less family stress, and more asthma follow-up visits, and were prescribed appropriate medications and peak flow meters more often than those students without a physician diagnosis of asthma. A physician commitment to or recognition of an asthma diagnosis is an important factor in subsequent asthma care.

The International Study of Wheezing in Infants: questionnaire validation

BACKGROUND

There are no internationally validated questionnaires to investigate the prevalence of infant wheezing. This study was undertaken to validate a questionnaire for the International Study on the Prevalence of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL).

MATERIAL AND METHODS

Construct and criterion validity were tested for the question 'Has your baby had wheezing or whistling in the chest during his/her first 12 months of life?'. Construct validity (i.e. the ability of parents and doctors to refer to the same symptoms with the same words) was tested in a sample of 50 wheezing and 50 non-wheezy infants 12-15 months of age in each of 10 centres from 6 different Spanish- or Portuguese-speaking countries. Criterion validity (i.e. the ability of parents to correctly detect the symptom in the general population) was evaluated in 2 samples (Santiago, Chile and Cartagena, Spain) of 50 wheezing and 50 non-wheezing infants (according to parents) of the same age, randomly selected from the general population, who were later blindly diagnosed by a paediatric pulmonologist.

RESULTS

Construct validity was very high (kappa test: 0.98-1) in all centres. According to Youden's index, criterion validity was good both in Cartagena (75.5%) and in Santiago (67.0%). Adding questions about asthma medication did not improve diagnosis accuracy.

CONCLUSIONS

The EISL questionnaire significantly distinguished wheezy infants from healthy ones. This questionnaire has a strong validity and can be employed in large international multicentre studies on wheezing during infancy.

Native and foreign born as predictors of pediatric asthma in an Asian immigrant population: a cross sectional survey

BACKGROUND

Asthma prevalence is lower in less developed countries and among some recent immigrant populations in the US, but the reasons for this are not clear. One possibility is that early childhood infections are protective against asthma.

METHODS

We surveyed Asian immigrant children (n = 204; age 4-18) to assess the relationship between asthma and native or foreign place of birth. We included questions about environmental exposures, demographic variables and family history of asthma to test whether they might explain effects of place of birth on asthma.

RESULTS

The native and foreign born groups were similar in most respects. Analysis of association with diagnosed asthma for all ages together resulted in two logistic regression models. Both retained born in the US (ORs were 3.2 and 4.3; p < 0.01) and family history of asthma (ORs were 6.4 and 7.2; p < 0.001). One model retained living near heavy motor traffic (OR = 2.6; p = 0.012). The other retained language (OR = 3.2; p = 0.003). However, for older children (11-18 years of age) being born in the US lost some of its predictive power.

CONCLUSION

Our findings are consistent with early childhood infections that are prevalent outside the US protecting against asthma.

Accuracy of Arabic versions of three asthma symptoms questionnaires against the clinical diagnosis of asthma

Validation studies of asthma symptom questionnaires against provocation tests of bronchial hyperresponsiveness have shown comparable performances of written and video taped questionnaires. This study aimed to determine the test characteristics of Arabic versions of two written and one video taped questionnaires when compared to the clinical diagnosis of asthma made by two respiratory physicians. The written International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire had higher sensitivities and greater accuracy than the other two questionnaires. Comparisons between corresponding questions and scenes in the ISAAC questionnaires in general revealed no significant differences in performance. The ISAAC written questionnaire had test characteristics consistent with its potential use as a screening instrument for asthma in this population of children.

Screening for asthma: results from a rural cohort

BACKGROUND

Asthma, the leading cause of chronic illness in children, must be managed in both the home and school environments. Identification of children who have risk factors associated with asthma is the first step toward achieving one of the Healthy People 2010 (2000) objectives, which identifies that 25 states will establish a system of surveillance to track asthma mortality, morbidity, access to care, and asthma management.

PURPOSE

The purposes of this research were to: a) identify rural children who are at risk for asthma through written screening; b) assess parameters of respiratory health status of rural school-aged children as indicated by forced expiratory volume at l second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), mean mid-expiratory flow (FEF(25-75)); and c) identify the number of rural school-aged children who sought and obtained follow-up from their primary health care provider and were given a definitive diagnosis of asthma.

FRAMEWORK

The Vulnerable Populations Framework (Flaskerud and Winslow, 1998) was used to organize this study.

METHODOLOGY

A prospective descriptive design was utilized for this research.

RESULTS

Approximately 12% of the children screened were referred to their primary care provider (PCP) for follow-up care. Of these approximately half of the children were seen by their PCP. Barriers to seeking follow-up care were: a) the child was not symptomatic all the time, b) reluctance to be diagnosed with asthma, and c) others, such as cost and time. Children who were not well controlled identified that they ran out of medicine and their parents did not refill their prescription.

CONCLUSION

Results from this descriptive study indicate that screening for asthma in school may be a way to identify those children who are at risk for asthma, and who are not diagnosed as well as those who are diagnosed with asthma but are not optimally managed. While many parents wanted their children to be screened, follow-up care was not critical to them.

IMPLICATIONS

Nurses working in a school setting are in a prime position to help identify those children with signs and symptoms of asthma. In addition, use of written screenings with or without spirometry may be helpful in identifying children at risk for asthma. Further studies need to be undertaken to determine if written screening is as efficacious as spirometry for school and other ambulatory care settings.

Asthma and wheezing symptoms in young people in six Western countries

BACKGROUND

Asthma diagnosed in children shows wide geographical variations. Large scale surveys identify children with diagnosed asthma, but neglect the group of youngsters with multiple asthmatic complaints.

METHODS

A short validated asthma questionnaire was included in six national surveys of the Health Behaviour in School-Aged Children Study. Prevalence rates are presented by country, gender and age. Gender and age differences are analysed using binary and multinomial logistic regressions controlling for age and smoking.

RESULTS

Large country differences are observed in the prevalence rates of diagnosed asthma (8.6%-20.9% in boys, 6.9%-18.5% in girls) and young people with "asthma-like symptoms" (9.6%-20.2% in boys, 9.2%-23.1% in girls). When controlling for age and smoking, significant gender differences are observed (more diagnosed asthma in boys, more asthmatic symptoms in girls). Age differences were observed in adolescents with "asthma-like symptoms", but not in diagnosed asthma.

CONCLUSIONS

Using a short asthma questionnaire, large differences in diagnosed asthma and wheezing symptoms are observed between the countries. A considerable group of youngsters with "asthma-like symptoms" is detected in all countries, and may be an unrecognised risk group in health promotion.

Comparison of parent and student responses to asthma surveys: students grades 3-12 and their parents from a suburban private school setting

Schools are being called upon to help address asthma, a common problem in school-aged children. School-based asthma programs need information about asthma diagnoses, asthma symptoms, and asthma's impact on school attendance. Parent or student surveys are the most common method of collecting these data. However, medical literature offers little guidance to help schools determine whether parents or students are the most appropriate and effective source of asthma-related information. This study compares student and parent responses to the same set of asthma-related questions. In general, parents and students have a high level of agreement in reporting the absence of an asthma diagnosis or asthma symptoms. When parents and students disagreed, students reported many more asthmalike symptoms, especially symptoms with exercise and symptoms at night, than did their parents. The disparity in student and parent symptom reporting did not vary by age of the student. Students appear to provide the most sensitive measure of asthma-related problems.

Evaluation and sustainability of the healthy learners asthma initiative

The Healthy Learners Asthma Initiative (HLAI) involved collaboration between Minneapolis Public Schools (MPS), local health care providers/payors, parents, and other partners. The intervention included development of enhanced asthma care in school health offices and clinic performance improvement projects to foster adoption of National Institutes of Health asthma guidelines. Goals were to improve asthma management among school children and reduce asthma-related school absences, hospitalizations, and emergency department visits. The effectiveness evaluation utilized a randomized community trial design with 16 elementary and middle schools matched and randomly assigned to either an intervention or a control group. Outcomes investigated were (a) school health office impacts and (b) school attendance. Data sources included school health office records, district attendance, enrollment, and demographics files. Following implementation of the HLAI, asthma visits to health offices were significantly lower in intervention schools compared to control schools (91 vs 121 visits per 100 students with asthma per month), and intervention schools had greater availability of medication and asthma action plans and more peakflow measurements, asthma education, and parent communication. Clinics initiated significantly more asthma action plans and sent them to MPS. Attendance differences between groups were limited to students who received asthma care through the school health office. Monitoring of asthma management activities provided through school health offices from 2002 to 2005 indicates sustained implementation of enhanced asthma care in schools and increased asthma communication between school, parents, and health care providers.

Racial and ethnic disparities in diagnosed and possible undiagnosed asthma among public-school children in Chicago

OBJECTIVES

We examined racial and ethnic disparities in the total potential burden of asthma in low-income, racially/ethnically heterogeneous Chicago schools.

METHODS

We used the Brief Pediatric Asthma Screen Plus (BPAS+) and the Spanish BPAS+, validated, caregiver-completed respiratory questionnaires, to identify asthma and possible asthma among students in 14 racially/ethnically diverse public elementary schools.

RESULTS

Among 11490 children, we demonstrated a high lifetime prevalence (12.2%) as well as racial and ethnic disparities in diagnosed asthma, but no disparities in prevalences of possible undiagnosed asthma. Possible asthma cases boost the total potential burden of asthma to more than 1 in 3 non-Hispanic Black and Puerto Rican children.

CONCLUSIONS

There are significant racial and ethnic disparities in diagnosed asthma among inner-city schoolchildren in Chicago. However, possible undiagnosed asthma appears to have similar prevalences across racial/ethnic groups and contributes to a high total potential asthma burden in each group studied. A better understanding of underdiagnosis is needed to address gaps in asthma care and intervention for low-income communities.

The Breathmobile Program: structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program

Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic "rescue" patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a continuity care model that has demonstrated efficacy over usual episodic care. More than 90% of patients in all asthma severity categories achieved clinical control of asthma with significant reductions in inpatient (IP) and emergency department (ED) use. On February 14, 2002, the program became the first program in the United States to receive the award of disease-specific care certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Proper design and resource allocation can sustain a school-based community-wide pediatric asthma disease management program and shift a population of inner city children from acute episodic care to routine preventive care in accordance with national standards. An evidence-based approach to evaluating and maintaining quality, coupled with stratified care delivery, can assure the efficient use of safety net healthcare resources.

Screening for asthma in Cantonese-speaking immigrant children

BACKGROUND

Asthma prevalence among Chinese immigrant children is poorly understood and attempts to screen these children have produced varied outcomes. We sought to learn how to improve screening for asthma in Chinese immigrant children.

METHODS

Children (n = 152) were administered the Brief Pediatric Asthma Screen in either Cantonese or English, they then viewed and reacted to a video showing people wheezing and subsequently took a pulmonary function test.

RESULTS

The diagnosed asthma prevalence for our study population was 27.0%, with another 5.3% having possible undiagnosed asthma. Very few children had spirometry findings below normal. In multivariate analysis, being native born (p = 0.002) and having a family history of asthma (p = 0.003) were statistically associated with diagnosis of asthma. After viewing the video, 35.6% of respondents indicated that the images differed from their conception of wheezing. Of four translations of the word "wheeze" no single word was chosen by a majority.

CONCLUSION

Our findings suggest that asthma diagnoses are higher for Chinese children who were born in the US suggesting that desegregation of data might reveal at risk subpopulations. Care needs to be taken when diagnosing asthma for Cantonese speakers because of the centrality of the word wheeze and the challenges of translation.

A brief questionnaire for screening asthma among children and adolescents in Rio de Janeiro, Brazil

BACKGROUND

Asthma is the most common chronic disease in childhood with recognition and detection still unsatisfactory. Questionnaires focusing on reported symptoms are a very promising and useful tool.

OBJECTIVE

To determine the diagnostic accuracy of a basic questionnaire (BQ) as a screening test for asthma in children and adolescents who sought medical assistance in a pediatric hospital in Duque de Caxias County, Rio de Janeiro State, Brazil.

METHODS AND RESULTS

A cross-sectional, observational, prospective study was carried out. A BQ with four questions was used to screen for asthma. The gold standard for a diagnosis of asthma was a minimum increase of 12 % in the first second of forced expiratory volume after a bronchodilatation test. Two hundred eleven patients, aged 5 to 15 years, who presented to the emergency department for various reasons were evaluated. The prevalence of asthma was 22 %. In 67 % of the families the annual income was less than USD 3600 and 60 % of support providers were illiterate or had less than 4 years of education. The test showed better performance when the answer to question 1 was considered separately: sensitivity = 74.50 % (95 %CI:60.50-84.70), specificity = 64 % (95 %CI: 56.40-71.10), positive likelihood ratio = 2.07 (95 %CI:1.59-2.70), positive predictive value = 37.20 % (95 %CI: 28.10-47.30), negative predictive value = 89.70 % (95 %CI: 82.90-94) and accuracy = 66.40 % (95 % CI: 55.80-78.30).

CONCLUSIONS

The BQ has high sensitivity and negative predictive values. It is easy to use and implement and is convenient for both the doctor and patient. It is useful for excluding a diagnosis of asthma in populations with a high or low prevalence of this disease, so long as there has been no wheezing in the previous 12 months.

Validation of a multistage asthma case-detection procedure for elementary school children

OBJECTIVE

The purpose of this study was to validate a 3-stage asthma case-detection procedure for elementary school-aged children.

METHODS

The study was performed in 10 elementary schools in 4 inner-city school systems, with a total enrollment of 3539 children. Results of the case-detection procedure were compared with the diagnosis of an asthma specialist study physician, to determine the sensitivity and specificity of the case-detection procedure.

RESULTS

Ninety-eight percent of children returned the asthma symptoms questionnaires, and 79% of those children consented to additional testing. Results indicated that the 3-stage procedure had good validity, with sensitivity, specificity, and predictive value of 82%, 93%, and 93%, respectively. A 2-stage procedure using questionnaires and spirometry had similar validity, with sensitivity, specificity, and predictive value of 78%, 93%, and 93%, respectively. However, given the time and expense associated with the 2- or 3-stage procedure and the difficulty of obtaining physician follow-up evaluation of the case-detection diagnosis, schools may prefer to use a 2-item questionnaire that has a lower sensitivity (66%) but higher specificity (96%) and predictive value (95%).

CONCLUSIONS

Case-detection programs are generally well received by school personnel and can identify children with unrecognized or undiagnosed disease, as well as those with a current diagnosis but poorly controlled disease. This study yields substantial information regarding the validity, yield, and specific types of children who might be identified with the use of such procedures. For the choice of the method of case detection used in a school, the strengths and weaknesses of each procedure, as well as the resources available for case detection, physician referral, and follow-up procedures, must be considered.

Development and validation of school-based asthma and allergy screening questionnaires in a 4-city study

BACKGROUND

Asthma and allergies are commonly undiagnosed in children. Schools provide settings for potentially accessing almost all children for asthma and allergy screening.

OBJECTIVE

To evaluate the feasibility and validity of using a questionnaire-based screening tool to identify undiagnosed asthma and respiratory allergies in children in kindergarten to grade 6.

METHODS

A student questionnaire (SQ) and a parent questionnaire (PQ) were developed, administered in 4 diverse communities, and validated against standardized clinical assessments. Children without diagnosed asthma and representing a range of symptoms participated in a validation study that consisted of independent, standardized, clinical assessments. Sensitivity, specificity, and predictive values for questionnaire items were evaluated against expert consensus designations.

RESULTS

A total of 190 children (age range, 7-13 years) completed the validation study. Affirmative responses to individual questions from either the SQ or PQ regarding asthma and allergy were modestly to moderately predictive of the clinical assessments (odds ratios, generally 2.5-5.0). When considering a positive asthma screen as affirmative responses to 3 of the best 7 SQ asthma questions, the odds ratio for asthma was 9.3 (95% confidence interval, 4.1-21.1), with 80% sensitivity and 70% specificity. Considering the allergy screen as positive based on affirmative response to either of the 2 SQ allergy questions yielded 81% sensitivity and 42% specificity.

CONCLUSIONS

Either a 9-item SQ or a 10-item PQ can be used in diverse settings to screen for asthma and respiratory allergies. The SQ, obtained by directly screening students, may provide a sensitive approach for detecting children with previously undiagnosed asthma and allergies.

Value of a shortened questionnaire in the description of asthma in 10-12-year-old pupils

Asthma is a common and severe chronic disease in children influencing their quality of life and functioning at school. A 5-item asthma-screening instrument was developed and tested in 1052 children aged 10-12 years. Questionnaires were completed by parents and children separately and data were compared. Children reported less to be diagnosed by a medical doctor as having asthma compared with their parents, although children reported more to have certain asthma symptoms. No difference in prevalence of asthma was found between children and parents' answers. The absolute agreement for the scale was 92% and a good kappa agreement was found. Recoding the "don't know"-answers in "no"-answers resulted in a 4% misclassification. The short 5-item asthma screening tool can be valuable in the categorization of a subgroup of children likely to suffer from asthma in a survey. Recoding 'don't know'-answers to 'no'-answers is justified in large samples

A school-based case identification process for identifying inner city children with asthma: the Breathmobile program

BACKGROUND

Striking increases in the prevalence and morbidity of asthma among inner city children have been documented.

OBJECTIVE

To establish and evaluate a large-scale, school-based case-detection process designed to efficiently and reliably identify inner city children with asthma.

METHODS

A bilingual, seven-question, self-administered, parental asthma screening survey was developed. Clinical validation was achieved in a sample of 675 consecutive parents bringing a child to the school-based Breathmobile Program for initial evaluation, using a comprehensive evaluation by a physician specialist (ie, allergist) as the standard. Survey response patterns were used to construct a novel seven-model, tiered scoring algorithm and an abbreviated algorithm that predict the probability of a child being clinically classified as "yes asthma" or "no asthma." A systematic survey distribution process administered by a single coordinator was developed, and the impact of a classroom-oriented incentive offering a 25 dollars school supply gift certificate for survey return rates of >or= 80% was evaluated.

RESULTS

A total of 636 parents provided one or more survey responses and information sufficient for clinical classification. The scoring algorithm correctly identified children with asthma (>or= 80% probability) with a sensitivity of 86.5%, a specificity of 83.6%, and a misclassification rate of 14.3% (91 of 636 children). The sensitivity for identifying persistent asthma was 91.3%. Asthma prevalence estimates derived using survey results from a larger sampling of the general population were similar to rates previously reported for comparable populations. The inclusion of an inexpensive incentive increased the median survey return rates from 35.3 to 65% (z= -11.9; p <.001). The screening process has been used to conduct 27,526 surveys at inner city schools.

CONCLUSIONS

The Breathmobile case-detection process offers a validated, comprehensive, large-scale method with which to identify children with asthma at their school sites.

Symptoms of asthma: comparison of a parent-completed retrospective questionnaire with a prospective daily symptom diary

In a study of the effects of indoor air pollution on the respiratory health of children in Newcastle, Australia, parental reports of symptoms experienced by children over the previous 12 months were compared with a prospective record of symptoms of cough and wheeze. Parents of 390 children aged 8-11 years completed a questionnaire about child and family respiratory health, which was used to assign children to one of four symptom groups: Wheeze (two or more attacks of wheezing in the last 12 months), Chest-Colds (two or more chest-colds in the last 12 months without wheezing), Cough Alone (a dry cough at night, without a cold or chest infection, that lasted for more than 2 weeks), or Control (none). A balanced sample of children (n=139) was invited to participate further by completing lung function tests, atopy testing, and keeping a daily diary of peak expiratory flow (PEF) and symptoms of cough and wheeze over a 7-week period. Valid data for the daily diary were provided by 66/85 (77.6%) of participants who commenced this stage (47.5% of the 139 invited to participate). The Wheeze group reported significantly more subsequent wheeze (median 16.8% of days) than the other three groups (median 0% of days). Parent reports of asthma-like symptoms over the previous 12 months were consistent with the subsequent experience of symptoms recorded in a daily diary.

Asthma prevalence among inner-city Asian American schoolchildren

OBJECTIVE

Though asthma has been studied in many inner-city populations in the United States, there have been no studies specifically on Asian American immigrants. The authors conducted a cross-sectional survey of the prevalence of asthma among schoolchildren at the Josiah Quincy Elementary School, located in Boston Chinatown. Roughly 62% of the students in the school are Asian American.

METHODS

The authors utilized the Brief Asthma Pediatric Screen (BAPS), a five-question instrument that was validated through the Chicago public schools. The survey was administered to kindergarten through fifth grade students.

RESULTS

Of the 606 respondents (69.9% of the students), 16% had previously diagnosed asthma and 3% had possible undiagnosed asthma. Asthma was more prevalent in boys than in girls (relative risk [RR] 1.75; 95% confidence interval [CI] 1.20, 2.56). In addition, the respondents who lived in Chinatown were less likely to have been diagnosed with asthma (RR 0.59; 95% CI 0.39, 0.90), as were those with Asian surnames (RR 0.65; 95% CI 0.44, 0.97).

CONCLUSION

Although this study was preliminary, our results suggest that asthma rates are substantial among inner-city Asian immigrant children, but possibly lower than for other inner-city children.

Development and validation of school-based asthma and allergy screening instruments for parents and students

BACKGROUND

The increasing morbidity attributable to asthma among school-aged children suggests the potential utility of school-based asthma screening programs.

OBJECTIVE

We report our efforts to develop and validate culturally sensitive and clinically useful screening questionnaires (parent and child versions) for asthma and allergies among urban US school children.

METHODS

Instrument development was accomplished through literature review, expert medical and child developmental input, focus group feedback, and a rigorous trial of the instruments in a public school setting. Questionnaires were distributed to 2,800 children and their families in an urban public school system (grades kindergarten through 6). Validity was evaluated by blinded comparison of results against a standardized clinical evaluation in 107 children, with final designations determined by an expert panel.

RESULTS

Questionnaires pertaining to 2,083 children were returned (participation rate of 74%). A moderate level of agreement was observed between parent and student questionnaire responses (r values = 0.36 to 0.50; P values < 0.001). The highest frequency of asthma-like symptoms was reported for African-American boys and the lowest for Caucasian girls. The items from the parent questionnaire that best predicted asthma were "breathing problems" (occurring rarely or more; odds ratio 12.8; 95% confidence interval, 4.5 to 36.1) and "problems coughing" (sometimes or more; odds ratio 9.7; 95% confidence interval, 3.6 to 26.5). Considering the presence of cough (sometimes or more) and/or breathing problem (rarely or more) yielded a sensitivity of 80%; a specificity of 75%, a positive predictive value of 50%, and a negative predictive value of 92%. Similar levels of prediction were observed for the items "trouble breathing" and "noisy breathing" as directly reported by the students. Allergic rhinitis was best predicted by report of a runny/stuffy no se (sometimes or more; sensitivity of 83%, specificity of 61%). Allergic conjunctivitis was best predicted by "itchy eyes."

CONCLUSIONS

Administration of a school-based questionnaire is feasible, with a high response rate and excellent internal consistency. A high sensitivity and acceptable specificity was achieved by using one to two questions for asthma, allergic rhinitis, and allergic conjunctivitis. Among the children in grades 2 or above, comparable levels of prediction could be achieved with the student or parent version.

Outcome results of a school-based screening program for undertreated asthma

BACKGROUND

Undertreatment of asthma is associated with significant potentially preventable morbidity, including frequent school absences. Guideline dissemination and clinician education have met with variable success. School-based identification of children with potentially undertreated asthma may provide an alternative strategy for improving asthma management in children.

OBJECTIVE

To evaluate the effectiveness of school-based identification of potentially undertreated asthma.

METHODS

A controlled trial of school-based identification of children with known but symptomatic asthma using mailed parent surveys, letters recommending medical follow-up, and medical record review to evaluate changes in asthma treatment after referral.

RESULTS

Most parents (79.9%, n = 5,116 respondents) responded to the survey and 19.4% (n = 994) of children were reported to have a physician diagnosis of asthma or reactive airway disease. Letters of referral were sent to 489 children with parent-reported asthma who were identified as having potentially undertreated asthma. Approximately one-third (31.2%, n = 153) of these children had physician visits, and 92 (18.8% of all referred) had documented medication changes. In addition, there were 20 new physician diagnoses in this group of children. In the control group of 604 children with asthma, there were significantly fewer children with asthma-related visits (131, 21.7%, P = 0.0004) and children with medication changes (74, 12.3%, P = 0.002) in a comparable 6-month window.

CONCLUSIONS

School-based screening or case identification increased the number of physician asthma-related visits and changes in asthma therapy.

Development and validation of a brief pediatric screen for asthma and allergies among children

BACKGROUND

Asthma is the most common disease of childhood, but the recognition and detection remain poor, especially among schoolchildren. There has been an increase in the number of instruments available to detect the risk of asthma earlier in children. We have previously validated a simple, self-reported screen, the Brief Pediatric Asthma Screen (BPAS).

OBJECTIVE

To develop a new screen for asthma and allergies based on the BPAS (BPAS+) with the intent of keeping the screen brief and simple, while including allergy detection.

METHODS

Questions from the BPAS were extensively revised, and questions regarding allergic rhinitis were added. A panel of parents of asthmatic children reviewed and critiqued the questions. The final BPAS + was distributed in elementary schools, and a cohort of 129 participated in a validation against the gold standard of evaluation by an expert in asthma.

RESULTS

For asthma the best items were wheeze, persistent cough, night cough, and response to change in air temperature. The simplest scoring, any 1 of the 4 items, yielded the best balance of specificity (73.6%) and sensitivity (73.3%). For allergy, using all six items, having any one or any two of the items had sensitivity of 71.4% and specificity of 77.3%.

CONCLUSIONS

The BPAS+ provides a rapid and valid method for the detection of potential allergy and asthma in schoolchildren. Sensitivity and specificity are acceptable for both asthma and allergies.

Family history as a predictor of asthma risk

Asthma, one of the most important chronic diseases of children, disproportionately affects minority and low-income children. Many environmental risk factors for asthma have been identified, including animal, mite, and other allergens; cigarette smoke; and air pollutants. Genetics also play an important causative role, as indicated by familial aggregation and the identification of candidate genes and chromosomal regions linked to asthma risk. Using a positive family history of asthma to identify children at increased risk could provide a basis for targeted prevention efforts, aimed at reducing exposure to environmental risk factors. To assess the predictive value of family history as an indicator of risk for childhood asthma, we reviewed population-based studies that evaluated family history of asthma and atopic disease in children with asthma. Our search identified 33 studies from all geographic regions of the world for review. The studies varied in definitions of positive family history and asthma phenotype and used study populations with asthma prevalence ranging from 2% to 26%. Nevertheless, family history of asthma in one or more first-degree relatives was consistently identified as a risk factor for asthma. In ten studies, sensitivity and predictive value of a positive family history of asthma could be calculated: sensitivity ranged from 4% to 43%, positive predictive value from 11% to 37%, and negative predictive value from 86% to 97%. Although a positive family history predicts an increased risk of asthma, it identifies a minority of children at risk. Positive family history may have utility in targeting some individual prevention efforts, but the low positive predictive value limits its value as a means to direct environmental remediation efforts.

Issues in identifying asthma and estimating prevalence in an urban school population

This article first presents salient issues related to identifying children in urban schools who might benefit from asthma services. It discusses a brief questionnaire for identifying cases and problems in estimating asthma prevalence. Subsequently, results of case detection in 14 urban schools are presented and discussed in light of these issues. The questionnaire was employed with parents of 4,653 African-American children in Detroit. Results suggest that determining number, type, and frequency of symptoms may be necessary to ascertain prevalence of asthma. Using only number and type produced a rate of asthma of 25%. Adding frequency provided a more conservative estimate of 19%. About 9% of children exhibiting symptoms of asthma had no physician diagnosis. Only 25% with symptoms reflecting mild persistent, 35% with moderate persistent, and 26% with severe persistent disease had prescriptions for anti-inflammatory medicine. Further, 23% of children with asthma-like symptoms had no prescription for asthma medicine of any type.

CONCLUSIONS

(1) low-cost procedures can be used in schools to identify children with suspected undiagnosed and undertreated asthma; (2) prevalence estimates for asthma in the group of urban school children studied are among the highest in the United States; and (3) asthma is undertreated in this sample.

Asthma screening as part of a routine school health assessment in the Australian Capital Territory

OBJECTIVE

To determine the feasibility and performance of a routine screen for childhood asthma in new entrants to primary school relative to diagnosis by a paediatrician.

DESIGN

Cross-sectional study with a validation substudy.

PARTICIPANTS AND SETTING

All 4539 new primary school entrants (mean age, 5.72 years; 95% CI, 5.71-5.74) in the Australian Capital Territory (ACT) in 1999; 180 of these children (73% of the 248 contacted) participated in the validation substudy.

MAIN OUTCOME MEASURE

Performance of the screening test relative to a paediatrician's diagnosis of current asthma (defined as a history of wheeze suggestive of a clinical diagnosis of asthma within the past 12 months) based on history and examination.

RESULTS

3748 of the 4539 new primary school entrants (83%) returned completed asthma and respiratory questions. The screening test was positive in 38% of children. Estimated sensitivity was 92% (95% CI, 75%-99%); specificity, 76% (95% CI, 72%-80%); positive predictive value, 51% (95% CI, 41%-63%); negative predictive value, 98% (95% CI, 90%-100%); positive likelihood ratio, 3.8 (95% CI, 2.8-4.8); and negative likelihood ratio, 0.14 (95% CI, 0.02-0.33).

CONCLUSIONS

It is feasible to conduct population screens for asthma that have good diagnostic test performance against a specialist paediatrician's diagnosis through school health programs. This approach could facilitate monitoring changes in asthma prevalence over time.