Jones CA, Morphew T, Clement LT, et al. Chest. 2004;125:924–934
Purpose of the Study.
To evaluate the effectiveness of a school-based screening survey to detect asthma in a large population of inner-city schoolchildren
Parents of schoolchildren in the Los Angeles, California, area.
A bilingual 7-question self-administered parental asthma-screening survey was administered to 675 consecutive parents before enrolling their children in a free mobile asthma program, the Breathmobile. Participants were recruited by either fliers distributed at the school or referral from school nurses. Surveys were validated by comparing responses to the presence and severity of asthma as determined by the allergist evaluating the patient on the Breathmobile using National Heart, Lung, and Blood Institute guidelines. The surveys (n = 27 526) then were distributed to 1212 classrooms in 24 participating schools, with incentives offered to the teachers for high return rates.
For survey validation, parental responses for 636 children were compared with physician classification, and the combination of questions that provided the best overall sensitivity and specificity were determined. Based on this algorithm, an abbreviated 5-question survey was developed with a positive classification resulting from a “yes” to asthma diagnosis or to any 3 of the following: chest tightness, trouble breathing, or exercise-induced and daytime symptoms. This survey was evaluated in a larger population of schoolchildren, yielding a sensitivity of 83.4%, specificity of 85.4%, positive predictive value of 93.9%, and negative predictive value of 65.5%. Offering a $25 school-supply gift-certificate incentive increased survey return rates from 35.3% to 65%, with return rates of ≥80% in many classrooms. A prevalence estimate of 14.1% children with probable asthma in Los Angeles schoolchildren was calculated by using this model.
The abbreviated 5-question survey yielded similar results when compared with the 7-question original survey. The surveys were easily distributed and analyzed with limited personnel using scanning software. The survey has been a useful tool for screening schoolchildren who may benefit from Breathmobile services and is an effective screening tool to identify children with probable asthma in this population of inner-city schoolchildren.
This article describes the utility of a brief survey in identifying children with asthma in an inner-city, primarily Hispanic population. This survey has been used by the Los Angeles Breathmobile to screen >25 000 children, and it has been the model for similar surveys used by the 4 other Breathmobile programs in the country. Jones et al should be commended for their trailblazing work in the development and success of the Breathmobile. We look forward to additional publications describing this very successful program.