Screening for Underdiagnosed Childhood ASTHMA in BATUMI (GEORGIA)

Abstract

Low prevalence of childhood asthma in the Batumi Region suggests around 65% underdiagnosis of the disease. The aim was population-based screening and clinical examination for asthma in children (6-7 y-rs).

Questionnaire on respiratory symptoms and diseases was addressed to 6320 grade-one children in Batumi via all 34 elementary schools. Children with asthma-like symptoms or diagnosed spastic bronchitis were invited to clinical examination, spirometry, FeNO and allergy tests. The diagnosis of asthma was made according to the GINA guidelines.

According to the responses from 5145 parents (response rate: 81.4%) 143 children (2.8%) had already diagnosed asthma, 506 (9.8%) had spastic bronchitis and not asthma (Group SB) and 393 (7.6 %) had only asthma-like symptoms (Group AS). Groups SB and AS underwent a step-wise clinical assessment resulting in newly-diagnosed asthma diagnoses in 43 (8.5%) SB children and in 40 (10.2%) AS children. In 5002 children without known diagnosis of asthma, the positive questionnaire screening was found in 899 children (17.4%) out of whom 83 (9.2%) had finally clinically confirmed asthma. In 816 children (16.3%) questionnaire screening was a false positive. Moreover it revealed 83 newly-diagnosed in addition to 143 already known cases of asthma thus resulting in the corrected 4.4% prevalence of asthma in 6-7 y-rs children.

Questionnaire-based screening for childhood asthma is a simple and acceptable tool at least in population suspected for underdiagnosis of the disease. Moreover, a low rate off false-positive results is in favour of questionnaire-based screening, however the ultimate decision regarding its implementation depends on the availability of clinical allergy/respiratory pediatric service.