Predicting asthma in preschool children at high risk presenting in primary care: development of a clinical asthma prediction score

Abstract

Background: A setting-specific asthma prediction score for preschool children with wheezing and/or dyspnoea presenting in primary healthcare is needed since existing indices are mainly based on general populations. Aims: To find an optimally informative yet practical set of predictors for the prediction of asthma in preschool children at high risk who present in primary healthcare. Methods: A total of 771 Dutch preschool children at high risk of asthma were followed prospectively until the age of six years. Data on asthma symptoms and environmental conditions were obtained using validated questionnaires and specific IgE was measured. At the age of six years the presence of asthma was assessed based on asthma symptoms, medication, and bronchial hyper-responsiveness. A clinical asthma prediction score (CAPS) was developed using bootstrapped multivariable regression methods. Results: In all, 438 children (56.8%) completed the study; the asthma prevalence at six years was 42.7%. Five parameters optimally predicted asthma: age, family history of asthma or allergy, wheezing-induced sleep disturbances, wheezing in the absence of common colds, and specific IgE. CAPS scores range from 0 to 11 points; scores <3 signified a negative predictive value of 78.4% while scores of ≥7 signified a positive predictive value of 74.3%. Conclusions: We have developed an easy-to-use CAPS for preschool children with symptoms suggesting asthma who present in primary healthcare. After suitable validation, the CAPS may assist in guiding shared decision-making to tailor the need for medical or non-medical interventions. External validation of the CAPS is needed.

Factors predicting persistence of early wheezing through childhood and adolescence: a systematic review of the literature

“…Severe recurrent wheezing (indicated by at least two previous hospital admissions due to exacerbation) was an independent predictor of current asthma at the age of 13 years among a population of recurrent wheezing children aged under 36 months (OR=2.3; 95% CI: 1.3–4.2; p =0.007) 26. Wheezing-induced sleep disturbances and wheezing in the absence of a cold were identified as two of the five independent predictors of asthma diagnosis at age 6 (OR=2.08; 95% CI: 1.31–3.29; p =0.002, and OR=2.22; 95% CI: 1.23–3.99; p =0.008, respectively) 17. Wheezing without colds, exercise-related wheeze/cough (wheeze or a cough with running, playing, laughing, or crying), and more than three episodes of wheezing attacks (OR=1.40; p <0.001, OR=1.26; p <0.001, and OR=1.65; p <0.001, respectively) were three of ten predictor variables included in the tool proposed for predicting asthma at school age 18.…”

“…Also, age (years) was positively correlated with a greater probability of asthma at the age of 6 years in the multivariable analysis in the Airway Complaints and Asthma Development (ARCADE) study (OR=1.47; 95% CI: 1.24–1.75; p <0.001) 17. Age >1 year was one of the ten predictor variables included in the tool proposed by Pescatore et al18 Likewise, Reijonen et al identified age ≥12 months on entry as an independent predictor of asthma at the median age of 4 years (OR=4.1; 95% CI: 1.59–10.35; p =0.0034) 27…”

“…Vial Dupuy et al, in a population of 200 infants under 2 years of age diagnosed with recurrent wheezing, reported that family history of asthma was an independent predictor of persistent asthma at the age of 6 years (OR=2.4; 95% CI: 1.3–4.5; p =0.007), and this was one of the three predictor variables included in their proposed score 16. van der Mark et al, in a population of 438 children aged 1–5 years attended in primary care for recurrent coughing, wheezing, and shortness of breath, identified that family history of asthma or allergy (asthma or allergy in parents and siblings) was one predictor variable for asthma at the age of 6 years, although it did not reach significance (OR=1.54; 95% CI: 0.98–2.41; p =0.060) 17. Pescatore et al, in a study carried out in Leicestershire, UK, on a population-based cohort of 1126 children aged 1–3 years with parent-reported wheeze or a chronic cough (a cough without colds or a cough at night) with one or more visits to the doctor for wheeze or cough during the previous 12 months, developed a tool for predicting asthma at school age.…”

“…Amat et al identified allergic sensitization to multiple aeroallergens (defined as two or more specific airborne allergen-positive IgE ≥0.35 kU/L) as an independent predictor of asthma at the age of 13 years among recurrent wheezing children aged under 36 months (OR=4.6; 95% CI: 1.9–11.2; p =0.001) 26. IgE polysensitization was an independent predictor of persistent asthma at 6 years of age (OR=6.1; 95% CI: 1.7–21.6; p =0.003), and was one of the three predictor variables included in the persistent asthma predictive score proposed by Vial Dupuy et al16 van der Mark et al identified specific IgE against cats, dogs, and/or house dust mites as one of the five independent predictors of asthma diagnosis at age 6 (OR=2.45; 95% CI: 1.38–4.33; p =0.003) 17. Aeroallergen-related wheeze/cough (OR=1.22; p <0.001) was one of the ten predictors included in the tool proposed by Pescatore et al18 Food allergy was identified as an independent predictor of symptom persistence up to school age in a population of children younger than 3 years with recurrent wheezing (OR=1.8; 95% CI: 1.2–2.5; p =0.002) 20.…”

Childhood Asthma-Predictive Phenotype

“…Several models of risk were generated to help identify those children who will continue wheezing into school age. [73][74][75][76][77][78][79][80][81] These models use risk factors associated with the development of asthma in epidemiologic studies such as a parental history of allergic sensitization, recurrent wheezing history, atopic disease in the child, increased IgE levels, decreased lung function, elevated exhaled nitric oxide, and increased T-helper-4 cytokine levels. One of the most studied, the Asthma Predictive Index (API), 73 was derived from the Tucson study data that includes risk factors, such as frequent wheezing, a parental history of asthma, and signs of personal atopic disease.…”