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

Yawn, Barbara P.; Wollan, Peter C.; Scanlon, Paul D.; Kurland, Margary

doi:10.1016/s1081-1206(10)61844-3

Cited by 37 publications

(31 citation statements)

References 43 publications

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“…Recent studies indicated that the prevalence of asthma among elementary school-aged children ranges from 10 to 20%. 18,19,33,34 Therefore, the predictive values of the procedures described are likely to be lower in practice than seen in this study population. Furthermore, when these procedures are used in a community setting, children will most likely be referred to their primary care practitioner, who may be less apt to make a diagnosis of asthma than were the specialists participating in this study.…”

Section: E464mentioning

confidence: 78%

“…Use of a broader definition of asthma on the questionnaire gives a very low predictive value and would result in referral to the physician of many children who do not actually have the disease. Studies have shown that it is difficult to get parents to follow-up on the referral, 33,35 and access to health care is difficult in many low-income areas. Therefore, one must be careful of overdiagnosing with a casedetection procedure.…”

Section: E464mentioning

confidence: 99%

“…35 However, the case-detection procedure did increase the rates of asthma-related office visits and medication changes for children with previously diagnosed asthma. 33 These changes might have long-term effects on days of school missed and numbers of emergency department visits and hospitalizations. Furthermore, all health care practitioners do not provide quality medical care for asthma that is delivered in accordance with NAEPP guidelines.…”

Section: E464mentioning

confidence: 99%

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Validation of a Multistage Asthma Case-Detection Procedure for Elementary School Children

Gerald

Grad²,

Turner-Henson³

et al. 2004

Pediatrics

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ABSTRACT. 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.

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Section: E464mentioning

confidence: 78%

Section: E464mentioning

confidence: 99%

Section: E464mentioning

confidence: 99%

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Validation of a Multistage Asthma Case-Detection Procedure for Elementary School Children

Gerald

Grad²,

Turner-Henson³

et al. 2004

Pediatrics

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“…54 Regardless of race, the prevalence of undiagnosed asthma is not easily compared across studies because estimates in the literature range from 5.3% to 20% depending on the symptoms, criteria, or both used. [55][56][57] Do those without a diagnosis benefit from treatment? A positive-intervention effect was reported in phase II of the National Cooperative Inner-City Asthma Study, which involved a randomized trial to evaluate the effectiveness of an asthma counselor in reducing asthmarelated morbidity among children with and without diagnoses.…”

Section: Secondary Prevention: Early Detection and Reduction Of Morbimentioning

confidence: 99%

Applying epidemiologic concepts of primary, secondary, and tertiary prevention to the elimination of racial disparities in asthma

Joseph

Williams

Ownby

et al. 2006

Journal of Allergy and Clinical Immunology

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Despite medical and scientific advances, racial and ethnic disparities persist in US asthma morbidity and mortality rates. Progress in the elimination of these disparities will involve disentangling the contribution of social constructs, such as race, socioeconomic status, and culture, from that of the physical environment and genetic susceptibility. One approach to reducing asthma disparities is through the traditional disease prevention stages of intervention. As such, primary prevention targets reductions in asthma incidence; secondary prevention is the mitigation of established disease and involves disease detection, management, and control; and tertiary prevention is the reduction of complications caused by severe disease. Once causative factors at each level of disease prevention are understood, this knowledge can be translated into clinical practice and public health policy.

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“…Although the cost/benefit ratio is always a concern for subjects identified at school, costs for inner-city children with asthma might actually be less, rather than more, if patients were given education and appropriately treated, because of fewer ED visits and hospitalizations. 42 Yawn et al 43,44 suggested that children who are previously undiagnosed and those with the diagnosis of asthma in the school setting infrequently seek medical care recommended by the school, to confirm the diagnosis and receive appropriate therapy. Those authors concluded that a school detection tool might be worthwhile for those previously diagnosed with asthma but not for those previously undiagnosed, in terms of accessing physician care.…”

Section: E312mentioning

confidence: 99%

Predictive Value of a Cross-Cultural Asthma Case-Detection Tool in an Elementary School Population

Galant¹

2004

PEDIATRICS

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ABSTRACT. Objective. Bronchial asthma, which affects ϳ5 million US children, is vastly underdiagnosed and treated, particularly among minorities and those of low socioeconomic status. Because current methods of detecting those at greatest risk of asthma in a multicultural setting appear inadequate, we assessed the validity and reliability of a new asthma questionnaire across 3 dominant cultures in Orange County, California (white, Hispanic, and Vietnamese).Methods. Children in grades 1, 3, and 5 and their families, in 3 different schools representative of these major ethnic groups, were randomly selected to participate in the validation process. Two schools with low socioeconomic status and dominant Hispanic or Vietnamese minorities were designated inner-city schools, whereas the third school was a suburban school with predominately white students. Participants completed a 7-question, 11-element questionnaire in their primary language, followed by an asthma evaluation (history, physical examination, and spirometry) by an asthma specialist (who was blinded with respect to the results of the questionnaire), at their respective schools. The physician then made a determination regarding the presence and severity (according to National Institutes of Health guidelines) of asthma. Several weeks later, the entire student body was asked to complete the questionnaire at home and return it to school for analysis. Validation of each item was evaluated for sensitivity, specificity, and positive and negative predictive values, and application of univariate analyses provided an estimated probability of an asthma diagnosis by the asthma specialist. A "bestfit" algorithm was determined with all 11 elements, if possible, and an abbreviated algorithm that selected the fewest-question combination that yielded the best asthma predictability was established. Reliability was established with the percent agreement between the 2 questionnaires and the statistic.Results. Of the 401 children/families who participated in the validation analysis, 45% were Hispanic, 22% white, 19% Vietnamese, and 15% other. The overall prevalence of asthma specialist-diagnosed asthma was 28%, with 65% of cases being graded as intermittent and 35% as persistent. Sixty-two percent of the children had not been previously diagnosed with asthma. There were no significant differences among cultures in sensitivity or specificity for any of the individual questions or the complete or abbreviated algorithms. The abbreviated algorithm with 3 questions, ie, question 1 (asthma in the past 2 years), question 4 (cough, chest tightness, trouble breathing, or wheezing with exercise), and question 6 (same symptoms in the morning or day in the past 4 weeks) yielded comparable sensitivity and specificity for the complete algorithm in all groups. The abbreviated algorithm had >86% predictability in detecting children with persistent asthma and 56% predictability in detecting children with intermittent asthma. Reliability was also excellent, with percent agreement usually > 80% ...

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

Cited by 37 publications

References 43 publications

Validation of a Multistage Asthma Case-Detection Procedure for Elementary School Children

Validation of a Multistage Asthma Case-Detection Procedure for Elementary School Children

Applying epidemiologic concepts of primary, secondary, and tertiary prevention to the elimination of racial disparities in asthma

Predictive Value of a Cross-Cultural Asthma Case-Detection Tool in an Elementary School Population

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