Asthma underdiagnosis in children: A school-based screening in a low socioeconomic status population
Abstract
Introduction. International asthma management and prevention recommendations emphasize the importance of early and accurate diagnosis and adequate disease control. However, these aspects remain a serious concern, especially in children with low socioeconomic status.
Objective. To describe asthma prevalence, underdiagnosis, severity, and control among children with low socioeconomic status in Bogotá, Colombia.
Materials and methods. We conducted a cross-sectional study using the International Study of Asthma and Allergies Questionnaire in children aged 7-11 in two public schools. The children with affirmative answers in the questionnaire were evaluated clinically and functionally at the mobile health care unit. Asthma prevalence, underdiagnosis, control level, severity, and patients’ quality of life were assessed with validated instruments.
Results. We screened 920 schoolchildren with an age of 9.5 ± 1.1; 186 were evaluated clinically and functionally by spirometry, and 122 of them were diagnosed with asthma (17.2%). Underdiagnosis was 68%. Most patients had moderate and severe asthma, and 90% were cases of not well or very poorly controlled asthma.
Conclusions. Screening children in school settings is a suitable strategy for detecting asthma and reducing underdiagnosis in communities with low socioeconomic status and limited access to health care services. The asthma underdiagnosis and poor disease control were high.
Downloads
References
1. World Health Organization. Global action plan for the prevention and control of NCDs 2013-2020. 2015. Accessed: December 21, 2018. Available from: https://www.who.int/nmh/events/ncd_action_plan/en/
2. GINA Report 2018. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma – GINA. Accessed: March 10, 2018. Available from: http://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/
3. Sinharoy A, Mitra S, Mondal P. Socioeconomic and environmental predictors of asthma-related mortality. J Environ Public Health. 2018;2018:1-7. https://doi.org/10.1155/2018/9389570
4. Bacon SL, Bouchard A, Loucks EB, Lavoie KL. Individual-level socioeconomic status is associated with worse asthma morbidity in patients with asthma. Respir Res. 2009;10:125. https://doi.org/10.1186/1465-9921-10-125
5. Perry TT, Vargas PA, McCracken A, Jones SM. Underdiagnosed and uncontrolled asthma: Findings in rural schoolchildren from the Delta region of Arkansas. Ann Allergy Asthma Immunol. 2008;101:375-81. https://doi.org/10.1016/s1081-1206(10)60313-4
6. Cohen RT, Celedón JC. Community violence and health disparities in asthma. J Pediatr. 2016;173:13-5. https://doi.org/10.1016/j.jpeds.2016.03.043
7. Dennis RJ, Caraballo L, García E, Rojas MX, Rondón MA, Pérez A, et al. Prevalence of asthma and other allergic conditions in Colombia 2009-2010: A cross-sectional study. BMC Pulm Med. 2012;12:17. https://doi.org/10.1186/1471-2466-12-17
8. Uphoff EP, Bird PK, Antó JM, Basterrechea M, von Berg A, Bergström A, et al. Variations in the prevalence of childhood asthma and wheeze in MeDALL cohorts in Europe. ERJ Open Res. 2017;3:00150-2016. https://doi.org/10.1183/23120541.00150-2016
9. Pesek RD, Vargas PA, Halterman JS, Jones SM, McCracken A, Perry TT. A comparison of asthma prevalence and morbidity between rural and urban schoolchildren in Arkansas. Ann Allergy Asthma Immunol. 2010;104:125-31. https://doi.org/10.1016/j.anai.2009.11.038
10. Brozek GM, Farnik M, Lawson J, Zejda JE. Underdiagnosis of childhood asthma: A comparison of survey estimates to clinical evaluation. Int J Occup Med Environ Health. 2014;26:900-9. https://doi.org/10.2478/s13382-013-0162-7
11. Amin P, Levin L, Smith A, Davis B, Nabors L, Bernstein JA. Asthma screening of inner city and urban elementary school-aged children. J Asthma. 2013;50:1049-55. https://doi.org/10.3109/02770903.2013.846370
12. Gerald LB, Redden D, Turner-Henson A, Feinstein R, Hemstreet MP, Hains C, et al. A multistage asthma screening procedure for elementary school children. J Asthma. 2002;39:29-36. https://doi.org/10.1081/jas-120000804
13. Jones CA, Clement LT, Hanley-Lopez J, Morphew T, Kwong KYC, Lifson F, et al. The Breathmobile Program: Structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program. Dis Manag. 2005;8:205-22. https://doi.org/10.1089/dis.2005.8.205
14. Martin MA, Mosnaim GS, Olson D, Swider S, Karavolos K, Rothschild S. Results from a community-based trial testing a community health worker asthma intervention in Puerto Rican youth in Chicago. J Asthma. 2015;52:59-70. https://doi.org/10.3109/02770903.2014.950426
15. Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC): Rationale and methods. Eur Respir J. 1995;8:483-91. https://doi.org/10.1183/09031936.95.08030483
16. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319-38. https://doi.org/10.1016/S2352-4642(17)30008-1
17. Butte NF, Garza C, de Onis M. Evaluation of the feasibility of international growth standards for school-aged children and adolescents. J Nutr. 2007;137:153-7. https://doi.org/10.1093/jn/137.1.153
18. Tauler E, Vilagut G, Grau G, González A, Sánchez E, Figueras G, et al. The Spanish version of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ): Metric characteristics and equivalence with the original version. Qual Life Res. 2001;10:81-91. https://doi.org/10.1023/a:1016622519987
19. Pearce N, Aït-Khaled N, Beasley R, Mallol J, Keil U, Mitchell E, et al. Worldwide trends in the prevalence of asthma symptoms: Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2007;62:758-66. https://doi.org/10.1136/thx.2006.070169
20. Martin M, Sauer T, Alarcon JA, Vinoles J, Walter EC, Ton TG, et al. Prevalence and impact of asthma among school-aged students in Lima, Peru. Int J Tuberc Lung Dis. 2017;21:1201-5. https://doi.org/10.5588/ijtld.17.0282
21. Okoromah CN, Oviawe O. Is childhood asthma underdiagnosed and undertreated? Niger Postgrad Med J. 2002;9:221-5.
22. van Schayck CP, van Der Heijden FM, van Den Boom G, Tirimanna PR, van Herwaarden CL. Underdiagnosis of asthma: Is the doctor or the patient to blame? The DIMCA project. Thorax. 2000;55:562-5. https://doi.org/10.1136/thorax.55.7.562
23. González-García M, Caballero A, Jaramillo C, Maldonado D, Torres-Duque CA. Prevalence, risk factors, and underdiagnosis of asthma and wheezing in adults 40 years and older: A population-based study. J Asthma. 2015;52:823-30. https://doi.org/10.3109/02770903.2015.1010733
24. Gupta M, Patodia J, Chaudhary P, Kakkar M. The rising trend of asthma prevalence in urban school children of Jaipur: A questionnaire-based study. Indian J Allergy Asthma Immunol. 2018;32:10. https://doi.org/10.4103/ijaai.ijaai_13_17
25. Murray C, Foden P, Lowe L, Durrington H, Custovic A, Simpson A. Diagnosis of asthma in symptomatic children based on measures of lung function: An analysis of data from a population-based birth cohort study. Lancet Child Adolesc Health. 2017;1:114-23. https://doi.org/10.1016/S2352-4642(17)30008-1
26. Foresi A, Leone C, Pelucchi A, Mastropasqua B, Chetta A, D’Ippolito R, et al. Eosinophils, mast cells, and basophils in induced sputum from patients with seasonal allergic rhinitis and perennial asthma: Relationship to methacholine responsiveness. J Allergy Clin Immunol. 1997;100:58-64. https://doi.org/10.1016/s0091-6749(97)70195-7
27. Meza ÉD, Uriel Ó, Puentes B, Del Pilar González Blanc J, García MG, Halley PD, et al. Evaluación del control del asma y la calidad de vida de los niños y sus padres o cuidadores en un programa de atención integral del asma (Programa Asmaire Infantil). Rev Med Sanitas. 2012;15:36-42.
28. Gerald JK, Grad R, Bailey WC, Gerald LB. Cost-effectiveness of school-based asthma screening in an urban setting. J Allergy Clin Immunol. 2010;125:643-50.e12. https://doi.org/10.1016/j.jaci.2009.12.984
Some similar items:
- Ernesto Pérez-Sánchez, Raúl Montiel-Cruz, Eréndira Romero-Domínguez, Griselda Pascacio-Bermúdez, Arturo Báez-Hernández, Guadalupe Díaz del Castillo-Flores, Fabián Correa-Morales, Gonzalo Vázquez-Prokopec, Pablo Manrique-Saide, Azael Che-Mendoza, Gabriela Meneses-Ruiz , Irma López-Martínez, María Jesús Sánchez, Seroprevalence of Trypanosoma cruzi among children from Veracruz, Mexico: Epidemiological baseline for a control model based on Chagas disease active transmission , Biomedica: Vol. 44 No. 1 (2024)
Copyright (c) 2025 Biomedica

This work is licensed under a Creative Commons Attribution 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |










