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

Abstract

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.

Underdiagnosis of childhood asthma: A comparison of survey estimates to clinical evaluation

“…However, such an observation is not isolated. In addition to the absence of respiratory symptoms as determined by questionnaire, some patients do not report their symptoms even during medical examination [20,23,25]. The finding could reflect a low parental concern over these symptoms in a child, low readiness to report mild, intermittent symptoms or insufficient ability to recognize the symptoms especially if their severity is low.…”

“…Interpretation was based on reference values established by Dockery and Hsu [17,18]. The submaximal exercise challenge step test was completed according to the protocol described by Gerald et al [19,20]. Briefly, the child stepped up and down on a single step maintaining a heart rate between 150-200 beats per minute for five minutes.…”

Quality of life protocol in the early asthma diagnosis in children

“…Study design is shown in Fig. 1 (27), was used. A sub-maximal exercise test (stepping up and down on a single step with metronome rhythm) was followed by spirometry obtained at minutes 3, 5 and 10 after exercise.…”

Socio-demographic factors related to under-diagnosis of childhood asthma in Upper Silesia, Poland

“…Lung function was considered normal if FEV 1 , FVC and PEF values were at least 80% of predicted values, and the FEV 1 /FVC ratio was greater than 75%. Bronchial hyperresponsiveness was examined using an exercise challenge test [12]. The procedure of the sub-maximal exercise test involved stepping up and down on a single step with metronome rhythm.…”