Pilot Study of a Screening Questionnaire for Asthma

Abstract

There is concern regarding the underdiagnosis and undertreatment of asthma in children. This pilot study was designed to determine the specificity, sensitivity, and feasibility of using a two-part (child + parent questionnaire) case finding tool (Video-guided Asthma Screening for Children-School Age, VASC-SA) to identify elementary school children with asthma. The child checklist includes two practice items and nine items asking about asthma symptoms and diagnosis. The items are visually cued using a 10-min videotape using split-screen vignettes, one corresponding to a no response (most children do not...) and one to a yes response (some children...). Three case definition algorithms were examined (all included inhaled medication, or current diagnosis, or wheeze with 0, 1, or 2 other symptoms). The VASC-SA was administered to English-speaking children in grades 1-4 from one school. All parents were sent a written asthma questionnaire. Positive screens were compared with diagnosis obtained from physician report or parent interview. Three-hundred fifty matched parent-child responses were analyzed. Asthma prevalence in this sample ranged from 14 to 14.9% using VACS-SA case definitions. Sensitivity for the three definitions ranged from 79 to 81% and specificity ranged from 94.5 to 95%. The predictive value positive ranged from 66 to 69% and predictive value negative was 97%. Concordance of child and parent reports was highest for previous asthma diagnosis and use of inhaled medication. The VASC-SA appears to be a promising new epidemiological tool to facilitate asthma screening in elementary schools. Prescreening children before parents may offer a practical approach in a large community-based population.