Asthma screening of high school athletes: identifying the undiagnosed and poorly controlled

Background: It is believed that there are many high school-age athletes who have undiagnosed asthma or exercise-induced asthma (ETA). The screening of these athletes for ETA will allow them to be identified and treated. Objectives: 1) To obtain reliable peak expiratory flow rate (PEFR) measurements and administer questionnaires to high school-age athletes to evaluate their asthma risk. 2) To identify high-risk athletes for having ETA or asthma by a free run challenge test. 3) To evaluate whether an athlete's present asthma control is adequate, 4) To evaluate these tools for their value as screening tools for asthma or ETA. Methods: Eight hundred one student athletes from 10 suburban Pittsburgh schools were screened for more than 18 months for asthma as part of their preparticipation sports physicals. The screening included all athletes from all high school sports. The athletes were given a brief questionnaire, had PEFR measured, and then participated in a free running exercise challenge. Results: Forty-six of 801 athletes had asthma or ETA, Of the remaining 755 athletes, 49 athletes were identified as having undiagnosed asthma. In the previously unrecognized athletes with ETA, the positive and negative predictive value of the questionnaire was 42% and 97%, respectively. Eighty-five percent (39 of 46) of the known asthmatic athletes, using their recommended medication, failed their free running test by a >15% drop of their PEFR. Conclusions: The free running test is a good test for identifying and assessing the athlete with ETA. The PEFR meter is not a good screening tool for ETA in the high school athlete. A questionnaire may be a good negative screening tool, but further development is needed before it can be used for widespread screening.