CURRENT CHALLENGES IN THE DIAGNOSIS OF CHILDHOOD BRONCHIAL ASTHMA AT THE PRIMARY HEALTHCARE LEVEL AND STRATEGIES FOR IMPROVEMENT

Abstract

Introduction: Bronchial asthma (BA) is a leading chronic respiratory disease in children, yet its diagnosis at the primary healthcare level is often delayed, leading to poorer outcomes. This study aimed to identify the key challenges in the timely diagnosis of childhood BA in the primary care setting and to propose effective strategies for improvement. Methods: A mixed-methods study was conducted involving 305 children in Andijan region, Uzbekistan. The study included a main group of 125 children (mean age 7 years) diagnosed with BA, a control group of 125 clinically healthy children (mean age 7 years) with a history of early-life wheezing, and a working group of 55 young children (mean age 3 years) with bronchial obstruction syndrome. Data were collected through retrospective analysis of medical records, prospective clinical-anamnestic evaluation, immunological assays (serum IgE), functional diagnostics (spirometry), and allergological tests. Statistical analysis was performed using SPSS version 26. Results: The average delay in BA diagnosis was found to be 2.8 ± 1.2 years after the onset of initial symptoms. Key reasons for delayed diagnosis included misinterpretation of recurrent wheezing as "obstructive bronchitis" (68% of cases), limited use of objective diagnostic tools like spirometry in children under 6 (55%), and low awareness of predictive risk factors among primary care pediatricians (45%). Children with a delayed diagnosis demonstrated significantly lower FEV1 scores (p < 0.05) and higher total IgE levels (p < 0.01) compared to those diagnosed early. An implemented electronic diagnostic support tool, based on a predictive model of risk factors, showed a 40% improvement in diagnostic accuracy for the working group. Conclusion: Delayed diagnosis of childhood BA at the primary care level is a significant problem driven by clinical, functional, and educational barriers. Overcoming these challenges requires a multi-faceted approach, including targeted training for pediatricians, wider implementation of age-appropriate functional diagnostics, and the integration of predictive digital support tools into routine clinical practice.