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.