[Underdiagnosed asthma in third-grade children]

Undiagnosed asthma has been poorly studied before adolescence since it can go unnoticed by parents and doctors. Moreover, it is unusual to look for undiagnosed asthma by directly questioning children on the presence of current respiratory symptoms. Epidemiologic studies show that more adolescents quote symptoms suggestive of asthma than the prevalence of doctor-diagnosed asthma, but respiratory symptoms compatible with asthma remain undetected by parents of younger children more frequently than doctors diagnose asthma in their children. We attempted to evaluate the relevance of a questionnaire used since 2011 by school doctors in Paris to detect asthma. In this questionnaire, the family history of atopy and asthma were completed by the parents when they met the school doctor (last year of preschool) and questions on current respiratory symptoms were answered by third-grade children seen alone by the school doctor. One hundred and thirty-one children out of 1135 children questioned had a positive questionnaire for suspected asthma. In three-quarters of the cases, questionnaires were positive based on the children's answers on their respiratory symptoms (without a positive answer on personal or family history being necessary). The outcome of 41 children screened by the questionnaire was known. Twenty (49%) children had received a final diagnosis of asthma, of whom 12 were put on asthma controllers. Among these 20 children, two children underwent lung function testing and two others underwent tests for allergy. In eight children, tests had been requested by the child's GP, but no final diagnosis was reported by the parents. None of the 13 children in whom asthma was ruled out had any test performed. It was concluded that it is possible to detect undiagnosed asthma in children as young as 8 years by directly asking them about their respiratory symptoms. The knowledge of personal and family history can improve screening for asthma in these children. A more thorough evaluation of all children with a positive questionnaire is necessary to better understand the properties of the questionnaire. Finally, the best way to implement this screening program remains to be established (school health, GPs).