Fran Lowry

November 22, 2011

November 22, 2011 (Boston, Massachusetts) — The elementary school setting might be ideal for screening children for asthma, according to research presented in a poster session here at the American College of Allergy, Asthma and Immunology (ACAAI) 2011 Annual Meeting.

Of 86 children who participated in a screening program conducted at 3 Cincinnati-area elementary schools, 55 (64%) were referred to their family doctor or an allergy specialist for further evaluation, reported Pryal Amin, MD, from the University of Cincinnati College of Medicine, Ohio.

The study found that younger children with a history of atopy were more likely to receive a physician referral for asthma.

"Although many elementary schools have nurses and even healthcare centers that are able to treat acute asthma symptoms, they often lack the ability to identify kids who have poorly controlled asthma, or even undiagnosed asthma," Dr. Amin told Medscape Medical News.

In this study, Dr. Amin and her colleagues sought to determine whether asthma screening in an elementary school setting was feasible using the ACAAI Nationwide Asthma Screening Program.

Their study involved children in grades 3 to 5 and was conducted in 1 urban and 2 suburban schools. The mean age of the children was 9 years and 10 months. During their screening visit, the children, aided by a school nurse or a physician, completed a 14-question asthma screening questionnaire, and their height and peak expiratory flow rates were measured.

Children were referred to a physician if they answered yes to more than 3 questions pertaining to possible asthma.

Peak flow readings ranged from 100 to 360 L/min (mean, 264 ± 58 L/min).

Children with known asthma or who were from the urban school answered "yes" to an average of 5 or 6 questions on the screening questionnaire, whereas children from the 2 suburban schools answered "yes" to an average of 3 or 4 questions.

There was no difference in the rate of physician referrals related to socioeconomic status or between urban and suburban schools.

"That was surprising," Dr. Amin noted. "We expected the rate of referral to be higher among the urban kids."

Senior author Jonathan A. Bernstein, MD, also from the University of Cincinnati, said that he believes that there is an unmet need for asthma screening among children in the United States.

"We want to use these data to demonstrate an unmet need in terms of identifying asthma at an early age. If we can do that, we can intervene early and we can prevent mild disease from becoming moderate to severe," Dr. Bernstein told Medscape Medical News.

The ACAAI's nationwide screening program was used as the study's "launching pad," he explained. "Screenings are done annually. Most people set them up in malls and places of that nature, but we decided to do this in elementary schools. They do have nurses or rotating nurses in these schools, but they are overworked and understaffed, so do not have the means to properly assess chronic diseases in kids. This leads to a lot of missed days from school and a lot of morbidity and social issues in terms of not being able to participate fully in school activities."

Gailen Marshall, Jr., MD, PhD, from the University of Texas, Houston, noted that it has long been recognized that underdiagnosed asthma is prevalent, especially in inner-city schools. So has the need for early screening and early diagnosis and care.

"The similar referral rates in the urban and suburban schools suggests that socioeconomic status is no longer the single or even the major factor that should be considered for children to be widely screened for asthma," he added.

Dr. Amin and Dr. Marshall have disclosed no relevant financial relationships. Dr. Bernstein reports financial relationships with Dynova, Flint Hills, Dyax, ViroPharma, Shire, CSL-Behring, Teva, AstraZeneca, and Pharming.

American College of Allergy, Asthma and Immunology (ACAAI) 2011 Annual Meeting: Abstract P76. Presented November 6, 2011.


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