Undiagnosed Asthma Identified During Routine Asthma Screening in the Primary Care Setting

Background: Asthma is the most common chronic disease among children. It remains a significant cause of morbidity, health care utilization and cost in the United States and is associated with long term health outcomes. Early and poorly controlled childhood asthma can potentially lead to the development of severe asthma in adults and irrecoverable loss of lung function leading to chronic obstructive pulmonary disease. As a result, a change in practice to better and earlier identify children at risk of adverse respiratory outcomes of asthma has been suggested. Although known prevalence of asthma in non-Hispanic Black and low-income children are higher, it is thought that the prevalence of asthma is still underestimated in these subpopulations.

The Kids Medical Mobile Clinic at Medstar Georgetown University Hospital’s Division of Community Pediatrics serves lower-income, predominantly African American children in Washington, D.C. To examine the asthma symptom and risk burden in the clinic as well as identify patterns of symptoms associated with underdiagnosis of asthma, an Asthma Symptom and Control Screen was designed and integrated on a mobile platform into routine well child screenings for ages 2 years and older (see Figure 1).

Methods: Data was retrieved and analyzed from the implemented Asthma Symptom and Control Screen on the Tonic Health mobile platform. The data set included the first screening for all children ages 2 years and above who had a screen completed at a well child visit between January 5 and June 30, 2021.

Results: 165 individuals completed the asthma screening tool. 34 (20.6%) reported a diagnosis of asthma. This was consistent with those who had a documented ICD10 code of asthma. Of the 131 with no previous diagnosis of asthma reported, 45 (34.3%) reported at least one asthma risk factor (coughing or shortness of breath at night, previous use of albuterol or exercise intolerance due to difficulty with breathing). 19.8% of children with no reported diagnosis of asthma had one asthma risk factor, 6.9% had two risk factors, 6.1% had three risk factors, and 1.5% had all four risk factors. The most common risk factor amongst children with no reported asthma diagnosis was stopping play or exercise due to difficulty breathing (18.3%), followed by night-time cough (16.8%), waking up at night short of breath (8.4%), and use of albuterol when sick (6.1%). (see Table 1).

Conclusion: In a population with a high prevalence of asthma, routine screening for asthma symptoms can potentially identify previously undiagnosed asthmatic patients. Early diagnosis and appropriate management can decrease long term poor health outcomes and improve quality of life.