VALIDATION OF SCHOOL BASED ASTHMA SCREENING PROGRAM

儿童哮喘往往诊断不足，这可能是一个严重的问题，因为延迟开始治疗是有害的。尽管最近儿童，特别是非洲裔美国儿童的哮喘患病率和发病率有所增加，但有效和可靠的哮喘筛查措施尚未制定。大多数哮喘筛查项目仅仅依赖于对症状问卷的回答。这些项目确定了大量“可能患有哮喘”的儿童，而这些儿童并没有真正患有这种疾病。阿拉巴马大学伯明翰分校（UAB）基于学校的哮喘筛查项目克服了这一缺点，采用了由问卷调查、基线肺活量测定和运动挑战测试组成的多阶段筛查程序。我们UAB学校哮喘干预研究（由NHLBI资助）先前的研究表明，在主要是非裔美国小学人群中进行哮喘筛查可以识别以前未诊断的哮喘病例。这些数据表明，该人群中有20%的哮喘患者在筛查程序之前未被诊断出来，这表明儿童中未确诊哮喘的负担很大。本项目的主要目的是计算UAB多阶段哮喘筛查程序的敏感性和特异性。几个次要目标也将得以实现。这些目标是：通过确定最能预测哮喘诊断的问题来完善哮喘症状问卷；并确定被调查者（父母或孩子）对哮喘症状报告的影响。一个简单的、基于现场的哮喘筛查项目的验证将是识别哮喘儿童的一个有价值的工具。这种筛查程序可以通过识别未确诊哮喘的儿童，从而降低哮喘发病率和死亡率。

Asthma in children is often under-diagnosed which can be a serious problem since delays in the initiation of therapy is deleterious. Despite recent increases in asthma prevalence and morbidity in children, especially African American children, valid and reliable asthma screening measures have not been developed. Most asthma screening programs rely solely on responses to symptoms questionnaires. These programs identify large numbers of children as "possible asthma" who do not truly have the disease. The University of Alabama at Birmingham (UAB) School Based Asthma Screening Program overcomes this disadvantage by using a multi-stage screening procedure composed of a questionnaire, baseline spirometry, and an exercise challenge test. Previous research in our UAB School Based Asthma Intervention Study (funded by NHLBI) has shown that screening for asthma in a predominantly African American elementary school population can identify previously undiagnosed cases of asthma. These data show that 20 percent of asthmatics in this population were undiagnosed prior to the screening procedure, indicating a substantial burden of undiagnosed asthma in children. The primary aim of this project is to calculate the sensitivity and specificity of the UAB multi-stage asthma screening procedure. Several secondary aims will also be accomplished. These aims are: to refine the asthma symptoms questionnaire by identifying questions most predictive of an asthma diagnosis; and to determine the effect of respondent (parent or child) on reports of asthma symptoms. The validation of a simple, field-based asthma screening program will be a valuable tool in the identification of children with asthma. Such screening procedures can lead to decreases in asthma morbidity and mortality by identifying children with undiagnosed asthma.