P4.040: Screening for Asthma and Related Environmental Risks in a High-Risk Pediatric Populations: A Descriptive Analysis of Universal Screening

Background: Asthma remains a significant cause of morbidity, health care utilization and cost in the United States and is associated with long term health outcomes. 1,2, Early recognition and intervention of asthma exacerbations are crucial to prevent the progression of asthma to severe stages.3 However, asthma is often underdiagnosed, particularly in children, and ongoing research is being conducted to identify predictive symptoms and factors for identifying children at risk for asthma. 3 In addition, environmental exposures that could trigger asthma-like symptoms in pediatric populations needs to be further investigated.4

The Kids Medical Mobile Clinic (KMMC) designed and integrated an Asthma Risk and Control Screen (ARCS) to identify patterns of symptoms associated with potential undiagnosed asthma in an urban patient population with known high prevalence.4,5,6 Home environmental risk is assessed using a question included in the KMMC Social Determinant of Health Screening, universally administered at each WCC.

The objective of this study is to assess the prevalence of previously unrecognized asthma and to identify associated home environment risks.

Methods: The ARCS was integrated into universal screening on the web-based TONIC platform in January 2021.
The study included unique children 2 years and above who had at least one WCC between January 2021 and December 2024. For ARCS, a positive screen included reporting coughing or shortness of breath at night, previous use of an inhaler, and exercise intolerance due to difficulty with breathing. Asthma diagnoses were based on ICD-10 codes in the chart either prior to or on/after date of the ARCS. The home environment screen is positive if answered “yes” or “maybe” to having seen mold, bugs, mice, rats, peeling paint or water leaking.

Results: 650 unique individuals completed the ARCS. 17.7% had a previous ICD10-diagnosis of asthma. 35% of individuals with no previous diagnosis of asthma reported at least one asthma risk factor. 24% of those individuals were subsequently diagnosed with asthma based on further clinical findings, which represented 7.8% of children screened. 38% of those individuals who had a prior diagnosis of asthma also reported yes to home environment risks. 52% of those individuals who reported asthma symptoms, but did not have a diagnosis of asthma reported yes to poor housing quality (Table 1).

Conclusion: Routine screening for asthma symptoms in a population with high prevalence can improve diagnoses. There is a high prevalence of poor housing quality in children with asthma, even higher with underdiagnosed asthma. Early diagnosis and appropriate management, that also addresses environmental triggers is needed for optimal treatment of high-risk populations. In answer to this, our team has developed a collaborative partnership with a community organization that does home-visiting, environmental evaluations and provides education, mold and pest remediation and advocacy.7