The authors of an abstract, “Screening for Asthma and Related Environmental Risks in a High-Risk Pediatric Populations: A Descriptive Analysis of Universal Screening,” will present their findings during the American Academy of Pediatrics 2025 National Conference & Exhibition at the Colorado Convention Center Sept. 26-30.
Authors identified a community that already showed a high prevalence of asthma cases and started universally screening all pediatric patients.
“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, MedStar Health pediatrician 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.”
Asthma is often underdiagnosed, particularly in children, and ongoing research is being conducted to identify environmental triggers in the home, such as mold, rodents or roaches.
The MedStar Health Kids Medical Mobile Clinic (KMMC) designed and integrated an Asthma Risk and Control Screen (ARCS) that evaluated 650 children ages two and older who had at least one well child visit between January 2021 and December 2024. Of that, 35% of individuals with no previous diagnosis of asthma reported at least one asthma risk factor, and 24% of those individuals were subsequently diagnosed with asthma based on further clinical findings.
Those who screened as positive for asthma reported coughing or shortness of breath at night, previous use of an inhaler, or exercise intolerance due to difficulty with breathing.
The study also found a high prevalence of poor housing quality in children in this population, about 41%, even higher, at 52%, for those that screened positive on the asthma symptom screen. The clinic has since developed a partnership with a home visiting program to remediate environmental triggers for children with asthma, as well as a medical-legal partnership to help advocate for safe and healthy housing.
The authors observe that children with asthma are more likely to miss school days, participate less in activities and sports, and have irregular sleep.
“Asthma is often diagnosed late or not at all because parents may not think of certain symptoms such as night-time cough or needing to stop activity to catch your breath, as being related to asthma,” said study author Janine A. Rethy, MD, MPH, division chief of Community Pediatrics at MedStar Health and associate professor at Georgetown University School of Medicine.
“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.”
The authors did not receive financial support for this research.
Dr. Ganacias will present the research from noon- 1 p.m. MDT Monday, Sep. 29, 2025, during the session hosted by the Council on Environmental Health and Climate Change Program in the Colorado Convention Center, Four Seasons Ballroom 1 & 2. To request an interview with the authors, contact Brendan Mcnamara at Brendan.T.Mcnamara@medstar.net.
In addition, Dr. Ganacias will be among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference from noon-1:30 p.m. MDT Saturday, Sept. 27, in the National Conference Press Room, CCC 705/707. During the meeting, you may reach AAP media relations staff at 303-228-8338.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
Program Name: 2025 Call for Abstracts
Submission Type: Council on Environmental Health and Climate Change
Abstract Title: Screening for Asthma and Related Environmental Risks in a High-Risk Pediatric Populations: A Descriptive Analysis of Universal Screening
Karen Ganacias
Washington, DC, United States
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.
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.
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).
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.
Table 1Results of universal screening for asthma symptoms and poor housing quality in a population with high prevalence
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