DENVER — A brief universal screening for asthma, even in a community with an already high prevalence of asthma, can further improve identification of children with undiagnosed asthma, according to a study presented at the annual meeting of the American Academy of Pediatrics (AAP) 2025 National Conference.

Using just three simple questions about signs and symptoms, researchers found that about 1 in 13 children they screened had undiagnosed asthma, reported Karen Ganacias, MD, MPH, MedStar Health pediatrician and assistant professor of pediatrics at Georgetown University School of Medicine in Washington, DC.

“We knew that asthma was often underdiagnosed or it was diagnosed late for a number of reasons.” The patient may go to the emergency room or urgent care and get albuterol or an inhaler but not get the diagnosis, and then that is not brought up to the pediatrician at their regular checkup, said Ganacias during a press conference at the meeting.

The Asthma Risk and Control Screen (ARCS) they developed asked whether the child had coughing or shortness of breath at night, whether they had ever needed to use an inhaler, and whether they had trouble doing physical exercise because of difficulty breathing.

Using just those three questions was “a great way to screen for asthma,” according to Irina Dralyuk, MD, pediatric pulmonologist at Cedars-Sinai Guerin Children’s in Los Angeles who was not involved in the study. Though more comprehensive questionnaires exist, this approach is practical “because it doesn’t burden the practitioner with too much time or an entire form that they have to commit to,” Dralyuk told Medscape Medical News.

In addition to the universal asthma screening, the researchers also screened for social determinants of health “to identify if there were certain environmental risks that put our patients at increased risk of having asthma symptoms, in an effort to help diagnose patients with asthma earlier and to begin treating their asthma more holistically,” Ganacias said.

The researchers conducted the study because they suspected that many children with asthma were being missed in their own community, so they were not surprised by the results, Ganacias said. Rather, the results validated their approach to routine screening, even in communities that already have many diagnosed with asthma, she said. Ideally, she would like to see all pediatricians include this screening in well-child visits if they can.

Dralyuk agreed that asking providers to do a full screening for every patient would be too much given other priorities at well-child visits, but asking three questions takes only about 2 minutes, she said.

“If you can diagnose early and you can start intervention early on any given child, you can prevent episodes,” such as visits to the emergency room or hospitalization, she said. Early diagnosis and intervention can also improve school attendance, parents’ ability to go to work, and the family’s overall quality of life, she added.

In the study, researchers assessed patients aged 2 years or older with at least one well-child visit between January 2021 and December 2024. Among 1593 patients with at least one visit, 650 completed the ARCS screen at least once. Half had a positive screen — answering yes to at least one sign or symptom — including 212 without a previous diagnosis of asthma (33%). After further workup, nearly a quarter (24%) of the patients with a positive screen and no previous asthma diagnosis were eventually diagnosed.

The researchers also screened for social determinants of health to assess families’ housing quality and potential for environmental asthma triggers. Among 1439 patients who completed this screening, 298 of them (21%) screened positive for poor housing quality. More than a third of those with poor housing quality had an asthma diagnosis (35%), and 45% of them had a positive ARCS screen.

Though the high rate of poor housing was also not a surprising finding, “it did encourage us to continue to expand our holistic approach to address environmental triggers in the home of asthmatic patients,” Ganacias said. “We have a partnership with an asthma home visiting program, but we have been encouraged to expand this to help identify and mitigate risks, like rodents and roaches and dust and mold,” she said.

The study reported receiving no external funding, and the authors and Dralyuk reported having no disclosures.

Tara Haelle is a science/health journalist based in Dallas.