Background: Bronchial asthma is one of the most prevalent chronic respiratory diseases in school-going children and contributes significantly to morbidity, school absenteeism, and impaired quality of life. Its burden is rising due to urbanization, environmental pollution, changing lifestyle, and increasing rates of obesity and atopy. Accurate local prevalence data and identification of modifiable risk factors are essential for planning targeted interventions.

Objective: To determine the prevalence and associated risk factors of bronchial asthma in school-going children from urban and rural settings using ISAAC criteria, and to compare asthma burden between these two sectors.

Methods: A cross-sectional observational study was conducted over 18 months (April 2024 – September 2025) among 300 school-going children aged 5–17 years selected from urban and rural schools in Jaipur, Rajasthan. Data were collected using a pre-designed ISAAC-based questionnaire, clinical examination, anthropometry, peak expiratory flow rate (PEFR), spirometry, forced oscillation technique (FOT), and laboratory investigations including absolute eosinophil count (AEC), venous eosinophil count (VEC), and serum IgE. Statistical analysis was performed using SPSS version 25.

Results: The prevalence of bronchial asthma was 18% (54/300). Mean age of asthma cases was 12.4 ± 3.1 years. Male sex (59.3%, p = 0.04), urban residence (59.3%, p = 0.03), and higher BMI (23.2 ± 3.5 kg/m², p = 0.01) were significantly associated with asthma. Wheezing was present in all asthma cases (100%); breathlessness in 85.2%; night cough in 77.8%; and chest tightness in 70.4%. Significant associations were observed with positive family history (55.6%, p = 0.002), passive smoking exposure (p = 0.018), allergic comorbidities including atopy (80%), allergic rhinitis (66.7%), and eczema (60%) (p = 0.001), perinatal factors including preterm birth (45%), low birth weight (40%), and maternal smoking (48.9%) (p = 0.01), poor household ventilation (29.5% vs 12.7%, p = 0.01), and obesity (30.0% vs 13.6%, p = 0.004). Serum IgE and eosinophil counts were significantly elevated in asthma cases (p < 0.001). Spirometry demonstrated an obstructive pattern in 85.2% of cases, with reduced FEV₁/FVC ratio; FOT confirmed increased airway resistance and peripheral airway involvement.

Conclusion: Bronchial asthma affects nearly one in five school-going children in this cohort and is strongly associated with multiple modifiable environmental, allergic, and lifestyle factors. Early school-based screening, smoke-free environments, obesity prevention, and timely medical management are essential to reduce disease burden.

KEYWORDS: Bronchial Asthma, School-going Children, Prevalence, Risk Factors, ISAAC, Spirometry, Pediatric Asthma, Urban, Rural.