Asthma-Related Symptom Burden Identified by School-Based Screening Among Apparently Asymptomatic Children in Western Uttar Pradesh: A Cross-Sectional Study

Abstract

Background: Asthma-related symptoms in school-aged children may be intermittent or mild and may not be apparent during a brief health assessment. Structured questionnaires can provide a practical approach to identifying symptom burden and children who may require further clinical evaluation. This study described the frequency and pattern of asthma-related symptoms identified by a 14-item questionnaire among apparently asymptomatic school children aged 8–14 years in Western Uttar Pradesh, India.

Methods: This cross-sectional school-based study included 370 children aged 8–14 years who were apparently asymptomatic at the time of screening. A 14-item yes/no asthma screening questionnaire developed by the American College of Allergy, Asthma and Immunology was administered. Each affirmative response contributed one point to a total score of 0–14. For the present study, more than five affirmative responses were defined as a positive questionnaire screen. Symptom frequencies and questionnaire-score distribution were summarized descriptively.

Results: The mean questionnaire score was 3.46 ± 3.60; the median was 2 (interquartile range 1–4), with a range of 0–14. Difficulty breathing around smoke or odors was the most frequently reported symptom (143/370, 38.65%), followed by frequent cough (124/370, 33.51%), difficulty breathing or coughing while walking upstairs (106/370, 28.65%), chest tightness or pain (103/370, 27.84%), and difficulty breathing or coughing while playing (100/370, 27.03%). Overall, 83 children (22.43%) met the study-defined threshold for a positive questionnaire screen.

Conclusion: Systematic symptom enquiry identified a substantial burden of asthma-related symptoms among children who were not presenting with active respiratory illness. Environmental and exertional symptoms were particularly frequent. Questionnaire positivity should be interpreted as a screening signal requiring appropriate clinical assessment and should not be considered equivalent to a confirmed diagnosis of asthma.