Discussion
The results from the present study confirm previous reports on the benefits of achieving an appropriate asthma diagnosis in young children. Those in whom asthma was diagnosed and treated appropriately following a positive screening questionnaire (16) showed improvements in lung function, reduction in symptoms, reduced health care service utilization and improved asthma control. On an individual basis, 318 (58%) children had improved asthma control, 289 (50%) children missed fewer day of school and 439 (80%) children had fewer visits to the emergency department for asthma-like symptoms.
Under diagnosis of asthma remains a major problem, especially in resource limited situations. The recently published “Worldwide Charter for Children with Asthma” (11) recognizes this issue as a major problem for children globally. The first item listed under the heading “Rights of Children with Asthma” is ‘I deserve a timely and accurate diagnosis of asthma within the primary care/community setting’. (11). As outlined by a recent Concise Clinical Review (21) “Under diagnosis can occur either because the patient has not communicated his/her symptoms to a physician, because the physician has not assigned a diagnosis to explain the patient’s symptoms, or because the physician has attributed the patient’s respiratory symptoms to a condition other than asthma.” In the LMIC setting one might add “where the family does not have access to appropriate health care” and in the pediatric setting, the failure to recognize asthma-like symptoms in young children further compounds the problem (9). The results from the present study show that under diagnosis can be a major problem in children in the early school years. Fourteen percent (900/6400) of children returned a positive screening questionnaire. We were able to contact and obtain data from 578 children and 95% (549/578) of these were diagnosed with and treated for asthma. Even if those families whose children had a very positive outcome from the screening questionnaire were more likely to respond to our contact attempts, this is still a remarkable outcome. Even if the 322 children whose families did not respond did not benefit, this still leaves 61% (549/900) children with major benefits from appropriate asthma diagnosis and treatment following the positive screening questionnaire. Extrapolating further, assuming the children of the 6,400 families completing the questionnaire were representative of the potential total 70,000 population, a positive screen rate of 14% (6,400/70,000) would see 9,800 children return a positive screening questionnaire, with between 5978 ( at a rate of 61%) and 9310 (at a rate of 95%) under diagnosed and under treated asthmatic children.
In summary, under diagnose and under treatment of asthma in the early school years remains a major problem in Argentina. The program of early detection of asthma with questionnaires in the province of Chubut, Argentina is an effective instrument to identify under diagnosed or undertreated asthmatic children and reduced morbidity, improve lung function and school attendance and reduce health care service utilization in young children.