School-Based Screening for Early Asthma among Asymptomatic School Children in Western Uttar Pradesh: A Cross-Sectional Study

Abstract

Background: Childhood asthma may remain unrecognized when symptoms are intermittent, mild or normalized by children and families. Schools provide an opportunity to identify children who may benefit from further respiratory evaluation. This study assessed the performance of a symptom-based asthma questionnaire in relation to peak expiratory flow rate (PEFR) among asymptomatic school children in Western Uttar Pradesh.
Methods: This observational cross-sectional study included 370 asymptomatic school children aged 8–14 years from a school in Greater Noida, Western Uttar Pradesh. Children with diagnosed asthma, respiratory medication use, acute or chronic respiratory illness, or active cough, wheeze or coryza were excluded. A 14-item American College of Allergy, Asthma and Immunology (ACAAI) asthma screening questionnaire was administered. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the receiver operating characteristic curve (AUC), diagnostic accuracy and Cohen’s kappa were calculated.
Results: The mean age was 12.06±1.00 years; 222 (60.0%) participants were female. Eighty-three (22.43%) children screened positive on the questionnaire and 53 (14.32%) had deranged PEFR. Mean PEFR was 275±76.66 L/min. Against the study-defined PEFR classification, questionnaire sensitivity was 73.58% (95% CI 59.67–84.74), specificity 86.12% (95% CI 81.82–89.73), PPV 46.99% (95% CI 35.93–58.26), and NPV 95.12% (95% CI 91.95–97.31). AUC was 0.80 (95% CI 0.75–0.84), diagnostic accuracy was 84.32%, and agreement was moderate (κ=0.483, p<0.0001).
Conclusion: The questionnaire identified a substantial group of children requiring further assessment and showed good discrimination against the study-defined PEFR classification, with a high NPV. However, neither questionnaire positivity nor reduced PEFR should be interpreted as a definitive diagnosis of asthma. School-based screening may serve as an initial case-finding strategy when positive screens are followed by appropriate clinical assessment and confirmatory pulmonary function testing.