Methods: We used responses from the School Inner-City Asthma Study (a NIH/NIAID prospective cohort evaluating school and classroom-specific environmental risk factors and asthma morbidity of urban children) screening surveys, to define who has asthma and symptoms of asthma without a provider-diagnosis of asthma based on questions identified by Gruchalla et al as having 100% predictive value for asthma. We computed descriptive statistics and analyzed asthma symptoms by race using Chi-square analysis.
Results: 7032 children were screened. Median age was 8 years [IQR 6-10]. Racial breakdown: 44% Hispanic, 30% Black, 13% White, 6% Mixed, 6% Asian, and 1% Native American. 22% of students reported a history of asthma and by race, 42% Hispanic, 35% Black, 10% White, 6% Mixed, 6% Asians, and 1% Native American, [p <0.0001].
269 (3.8%) of subjects reported asthma symptoms without a provider-diagnosis of asthma, which included a significant proportion from each race. The proportion was lowest in Whites at 2.6% (vs. 6.8% of Hispanics, 4.6% of Blacks, 4.6% of Mixed, 4.6% of Asians, 6.4% of Native Americans) [p<0.001].
Most asthmatic respondents reported significant morbidity. 68% reported missed school days or medical care in the past year due to asthma, which most Hispanics reported [p<0.05]. 77% had exercise-induced symptoms, which disproportionally affected Native Americans (87%) vs. the other groups (65-80%), [p=0.02]. 78% had nighttime symptoms [p=0.2].
Conclusions: School-based asthma screening surveys are useful in identifying students with uncontrolled asthma and asthma symptoms. About 3.8% of inner city school age children could have undiagnosed asthma. The proportion of children with undiagnosed asthma or uncontrolled asthma may vary by race. We hope that this data will provide: the framework for creating surveillance programs to identify asthma symptoms in underserved school-age children and the development of management and support systems for those students with poorly controlled asthma