Asthma Screening Research Articles

Validation of the Brief Pediatric Asthma Screen

The purpose of this study was to confirm the validity of a brief screen for pediatric asthma in schools. Asthma is the most common chronic disease of childhood, yet the frequency with which this condition is recognized among school-aged children varies widely. Several methods are used to increase the accuracy of detection of asthma, but many are cumbersome and difficult to apply on a large scale. We elected to validate a five-question instrument, the Brief Pediatric Asthma Screen (BPAS), to screen for the presence of asthma among children attending school in Region 5 of the Chicago school district, where the schools report a 2.7% frequency of asthma. The questionnaire was distributed to the parents of grade-school children at the time of report-card pick-up. A clinical assessment was performed on a selected group of children whose parents completed the questionnaire in a school and in a hospital outpatient clinic. Of 4,147 questionnaires that we distributed, 1,796 (43%) were returned. We excluded 341 children (19% of the total sample) whose parents reported that they had been diagnosed with asthma. The remaining pool indicated that the children of 183 responders (10%) had symptoms suggestive of asthma, while 1,272 parents (71%) indicated that their children did not have symptoms of asthma. We selected 90 of the respondents who did not indicate that their children had a diagnosis of asthma. Of this group, 81 completed the validation, in which their responses suggested symptoms of asthma (n = 34) or no asthma symptoms (n = 47). The children of these respondents were given a blinded clinical evaluation consisting of history, physical examination, and spirometry. The survey demonstrated a sensitivity of 75% and a specificity of 81.2% for the presence of asthma among those who were unaware of the diagnosis. The BPAS is brief, can be filled out by parents, and appears accurate in detecting asthma.

One Mile Run Asthma Screening in School Children

One Mile Run Asthma Screening in School Children

Is the level of pollutants a risk factor for exercise-induced asthma prevalence?

Increased prevalence of asthma is commonly though to be associated with increased air pollution and with lifestyle changes. This study evaluates a possible relationship of levels of exposure to outdoor pollutants and exercise-induced asthma prevalence. Two groups of students (age 14-17) in distant urban areas were randomly selected (n = 649): Group I (n = 430), Vancouver, B.C., Canada; Group II (n = 219), Prague, Czech Republic. The free running asthma screening test was performed at both locations; self-report questionnaires were distributed to all participants. Peak expiratory flow rates were used to evaluate baseline and postexercise spirometry. A 15% decrease was considered a positive response to exercise challenge. The information on ambient air quality (SO2, NO2, O3, PM10) was obtained from appropriate institutions. Of 649 subjects tested [Group I: n = 430, F = 251 (58.4%,) M = 179 (41.6%) and Group II: n = 219, F = 112 (51.6%), M = 107 (48.4%)], 81 of the participants (13.2%) responded positively to the exercise challenge [Group I: n = 55 (12.8%) and Group II: n = 26 (11.8%)]. Of the population tested, 150 (23.6%) participants self-reported a history of allergic disease [Group I: 94 (21.9%) and Group II: 56 (25.6%)]. The levels of air pollutants obtained for Group II significantly exceeded those obtained for Group I. This study reports a prevalence of 12.3% of exercised-induced asthma among high school students, when free running asthma screening test and peak expiratory flow rate are used. Significantly different levels of common pollutants do not correlate with asthma prevalence. Although it is recognized that air pollution is a well-known asthma trigger, it cannot be a simple explanation for the continued problem of rising asthma prevalence.

Screening for asthma in an inner-city elementary school in Minneapolis, Minnesota.

To the extent that the asthma morbidity so prevalent in children today is due to underdiagnosis or lack of appropriate treatment, schools are increasingly faced with the issue of defining their role in the care of children with asthma. This paper describes efforts to conduct schoolwide screening for asthma in an inner-city elementary school over the past two years. Screening methodology adopted for the project resulted in a simple and noninvasive approach for identifying children with current asthma in a school setting. While not as medically comprehensive as would be required to conclusively diagnose asthma, the simple screening approach proved efficient in identifying a population of elementary school children with a significant level of asthma morbidity. The paper discusses the effectiveness and feasibility of the screening efforts and proposes how such a screening program might be incorporated into the routine health activities undertaken at any elementary school.

Asthma in non-inner city Head Start children.

Asthma is a significant cause of morbidity and mortality in children. The objective of this study was to determine whether the federal program Head Start in Dane County, Wisconsin, could be used as a mechanism to identify preschool-aged children with asthma. Five-year, cross-sectional survey of parents with children enrolled in Head Start. Investigator-administered asthma screening questionnaire to parents of enrolling Head Start children in Dane County, Wisconsin. Asthma prevalence and asthma-related health care use, including emergency department visits, hospitalizations, and medication usage, were measured using an asthma screening questionnaire developed by investigators. Information was gathered on 2215 children. The prevalence of physician-diagnosed asthma in the screened children was 15.8%. Parental reports of physician-diagnosed asthma were validated in a subset of 133 children, with a 98.5% confirmation rate. Independent risk factors for asthma included male gender (relative risk, 1.4) and African-American ethnicity (relative risk, 1.4). Asthma-related morbidity was substantial with 26.7% of identified children hospitalized for asthma and 54.5% with an emergency department visit during their lifetime. The majority of children (46.4%) were treated with intermittent, quick relief medications (beta-agonists) alone, whereas only 6.1% were on daily, long-term controller medications. Asthma screening through a Head Start program provides an effective means of targeting preschool-aged children from socioeconomic groups at high risk for asthma. Identification of children early in the disease course and those at high risk for asthma provides an ideal opportunity for the implementation of preventive and therapeutic interventions.

Screening, Diagnostic and Outcome Tools for Asthma

Asthma is a chronic inflammatory disorder of the airways, affecting about 10% of children and 5 to 7% of the adult population. Improved asthma control will not only benefit the patient but will also result in reduced financial expenditure in asthma healthcare.

School-based asthma screening program.

School-based asthma screening program.

Screening to Help Asthmatics Breathe Easier

THE AMERICAN College of Allergy, Asthma & Immunology (ACAAI), Arlington Heights, Ill, has launched the first Nationwide Asthma Screening Program to help people with symptoms of asthma find the medical help and counseling needed to control the disease. The free asthma screenings will take place in shopping malls, civic centers, health fairs, and other public places in approximately 100 communities throughout the United States. The program that began in May seeks to encourage children and adults with breathing problems to speak with the allergists, respiratory therapists, and other health care providers who are volunteering their time and expertise at the screening sites. They will be invited to take a spirometer test and answer a 20-question Asthma Life Quality Test to help determine if a person has asthma and if the asthma is under adequate control. Based on the screening results, the participants will be counseled on whether they should seek

The free-running asthma screening test: an approach to screening for exercise-induced asthma in rural Alabama.

This study documented the prevalence of exercise-induced asthma (bronchospasm) in rural elementary schools and described the use of a free-running asthma screening test (exercise-challenge) and peak expiratory flow rate measurements for screening in a school setting. Of 437 children screened, 25 (5.72%) had a > or = 15% decrease in post-exercise peak expiratory flow rate which is indicative of exercise-induced asthma. Absenteeism and poverty were associated with findings of exercise-induced asthma. Early detection of exercise-induced asthma in school-age children through screening would facilitate early treatment, enhance exercise-related activities, and decreases school absences.

Incidence of exercise-induced asthma in high school population in British Columbia.

The Free Running Asthma Screening Test (FRAST) was performed on 830 randomly selected volunteers (age 14-17) chosen from British Columbia school students. An educational workshop on asthma was presented before testing. A self-reported questionnaire was distributed to evaluate predisposing factors. Air quality parameters were obtained on days of testing. FRAST was used to challenge exercise induced asthma (EIA). Peak expiratory flow rate (PEFR) was used to obtain baseline and post exercise spirometry. A 15% decrease in PEFR was considered a positive challenge result. Of 830 subjects tested, 110 (13.2%) responded positively to exercise challenge. Of the population tested, 21.8% self-reported a history of allergic disease, 76.4% of whom were from the positive responders' group. From the positive group only 72 (65.4%) were previously diagnosed as asthmatic. History of allergic disease was the strongest predisposing factor. The results indicate that inexpensive screening may improve early diagnosis and thus better preventive management.

Screening Adolescent Athletes for Exercise-Induced Asthma

To pilot test an exercise-induced asthma (EIA) screening program using a submaximal step-test and pulmonary function test (PFT) to identify athletes with EIA and to determine if a physical examination or self-reported history could be used to predict the existence of EIA. Screening and diagnostic testing using a convenience sample. Birmingham, Alabama, during athletic preparticipation examination (PPE). Fifty-two African-American, male football players aged 14-18 years being evaluated for participation in scholastic athletics. No athlete refused participation. Four were excluded because of need for further evaluation unrelated to any pulmonary condition. Each athlete completed a medical history, allergy history, physical examination, preexercise pulmonary function test (PFT), submaximal step-test, and a series of postexercise PFTs. Major outcome measurements were changes in forced expiration volume in 1s (FEV1) or peak expiratory flow rate (PEFR) after completing an exercise challenge. Seventeen of 48 athletes had a > or = 15% decrease in PEFR after exercise. Nine of 48 athletes had a > or = 15% decrease in FEV1 after exercise. The only self-reported item that differentiated subjects with normal and abnormal PFTs was a personal history of asthma (p < 0.05). Many athletes can be identified as having abnormal PFTs by use of a submaximal step-test as an exercise challenge. Self-reporting questionnaires and PPEs do not appear to be sensitive enough to identify athletes with this condition. If validated by future studies, this protocol could be used for the diagnosis of EIA.

Asymptomatic bronchial hyperreactivity and the development of asthma and other respiratory tract illnesses in children.

It is not clear whether asymptomatic bronchial hyperresponsiveness (BHR) in children is a risk factor for the subsequent development of asthma. A longitudinal study was conducted to determine the predictive value of BHR for the development of asthma in a primary care patient population. A standard free running asthma screening test (FRAST) was applied to 956 schoolchildren aged between 4 and 11 years in 1985. Peak expiratory flow (PEF) rates were measured before hard running for six minutes and following a three minute rest period. Children with a fall in PEF of more than 15% were labelled as having a positive FRAST. Clinical data from the patients' notes and from symptom questionnaires were compared with age and sex matched controls for children known to have asthma, and for those with a positive FRAST but no asthma (BHR group). Over the ensuing six years to 1991 further clinical data were gathered to compare the development of asthma and other diseases of the airways in both the BHR groups and their controls. Of the 956 children exercised in 1985, 60 who were not known to have asthma had an abnormal test. Of the 55 of these studied in 1991, 32 (58%) had developed asthma. The sensitivity of a positive FRAST for the development of asthma was 58%, its specificity 97%, and positive predictive value 72%. Hay fever, eczema, otitis media, "bronchitis," and family history of atopy also occurred more commonly in this group. Asymptomatic BHR, as shown by exercise challenge, can predict the development of clinical asthma. This study has also shown a relation between BHR, asthma, and other diseases of the airways, notably upper respiratory tract infection, "bronchitis," and otitis media.

Screening a state middle school for asthma using the free running asthma screening test.

The free running asthma screening test (FRAST) was used to screen children in a state middle school during a normal physical education lesson. The test was conducted by the teachers with a general practitioner available via a radiopager. Of the 249 children attending the school, aged 8-12 years, 237 (95%) were tested. Twenty two (9%) children were known to have asthma, of whom 18 were tested. Thirty one children had a significant decrease (> 15%) in their peak expiratory flow rate (PEFR) after exercise. Six of these children were known to have asthma, indicating that their asthma treatment may be suboptimal. A further six children assessed clinically had false positive results. The 31 children with significant decreases in their PEFR were matched for age and sex with a control group of 30 children who were considered to have a normal result. Of the control group, one child had clinical asthma. In total, 19 (8%) new cases of asthma were identified, giving an overall prevalence of asthma in the school of 16%. These results indicate that it is feasible to screen schools for asthma using the FRAST. Children with undiagnosed asthma can be identified and the control of children with known asthma monitored.

Relation between response to exercise and diurnal variability of peak expiratory flow in primary school children.

Variability in peak expiratory flow (PEF) has been proposed as a simple method of screening for asthma in epidemiological studies. This study was designed to assess whether the bronchial response to exercise and the diurnal variation in PEF identified the same subjects. Bronchial response to a free running exercise test was assessed in a cohort of 918 seven year old children and was compared with variability of PEF as assessed by twice daily recordings for a one week period. Mini Wright peak flow meters were used throughout the study. Baseline PEFs of both tests were highly correlated but there was no significant correlation between a response to exercise and variability of PEF. Of 33 children with a physician's diagnosis of asthma, 18 had at least one abnormal test, but only five children were abnormal in both tests, showing that the tests did not identify the same subjects. Increased variability of PEF, as well as a response to exercise, was associated with respiratory symptoms, but only a response to exercise was closely associated with atopy (defined as a positive skin test to any of seven aero-allergens).