Universal screening identifies undiagnosed asthma and environmental risks in high-prevalence communities

Universal screening identifies undiagnosed asthma and environmental risks in high-prevalence communities | Image Credit: © Anchalee - stock.adobe.com.

Universal screening for asthma symptoms and environmental triggers during routine well-child visits can help identify children with previously undiagnosed asthma, according to research presented at the American Academy of Pediatrics (AAP) 2025 National Conference & Exhibition in Denver, Colorado.^1,2

The study, Screening for Asthma and Related Environmental Risks in a High-Risk Pediatric Populations: A Descriptive Analysis of Universal Screening, was conducted through the MedStar Health Kids Medical Mobile Clinic (KMMC) and evaluated the effectiveness of the Asthma Risk and Control Screen (ARCS). Investigators assessed asthma symptoms alongside home environmental risk factors in children living in a community known to have high asthma prevalence.

“Although common in children and with significant morbidity, asthma is highly treatable if diagnosed early and approached with a holistic lens that includes identifying and addressing environmental triggers,” said study author Karen Ganacias, MD, MPH, pediatrician at MedStar Health and assistant professor of pediatrics at Georgetown University School of Medicine. “In populations with high asthma prevalence, routine screening for asthma symptoms and modifiable home environmental triggers can be an important first step to improving outcomes and decreasing disparities.”

Study design

The ARCS was integrated into the clinic’s web-based TONIC platform beginning in January 2021. Children aged 2 years and older who had at least one well-child check between January 2021 and December 2024 were included. Screening was conducted universally and incorporated into the KMMC’s broader social determinants of health assessment.

A positive asthma screen included reports of nighttime cough or shortness of breath, prior inhaler use, or exercise intolerance. Home environmental risk was assessed through caregiver responses about exposure to mold, pests, peeling paint, or water leaks.

Key results

The study included 650 unique children. Findings showed:

• Prevalence of asthma: 17.7% of participants had a prior ICD-10 diagnosis of asthma.
• Undiagnosed risk: Among children without a previous asthma diagnosis, 35% reported at least one asthma risk factor. Of these, 24% were subsequently diagnosed with asthma after further clinical evaluation, representing 7.8% of all children screened.
• Environmental risks: 38% of children with a prior asthma diagnosis reported poor housing quality. Among those with asthma symptoms but no diagnosis, 52% reported poor housing conditions.

These results demonstrate a clear link between environmental exposures and pediatric asthma. “There are also many environmental triggers in the home that may contribute to these symptoms and which a pediatrician should know about to help understand triggers and incorporate into a treatment plan. This study can open the conversation for screening for asthma and related environmental triggers for all children, especially when there is a high prevalence of asthma in the community,” said study coauthor Janine A. Rethy, MD, MPH, division chief of Community Pediatrics at MedStar Health and associate professor at Georgetown University School of Medicine.

Clinical and public health implications

Asthma is one of the most common chronic conditions in children and remains a leading cause of morbidity, health care use, and missed school days. The findings from this study reinforce the value of integrating symptom and environmental screening into routine pediatric care, particularly in high-risk urban populations.

To address identified risks, the clinic developed partnerships with community organizations to provide home visits, environmental evaluations, pest and mold remediation, and housing advocacy. The study authors emphasized that early recognition and intervention can help prevent progression to more severe asthma and improve long-term outcomes.

References:

1. American Academy of Pediatrics. Researchers find benefit in routine asthma screening in communities with high asthma prevalence. Eurekalert. September 26, 2025. Accessed September 26, 2025. https://www.eurekalert.org/news-releases/1098728?
2. Ganacias K. Screening for Asthma and Related Environmental Risks in a High-Risk Pediatric Populations: A Descriptive Analysis of Universal Screening. Abstract. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.