Asthma and lower airway disease
Predicting the long-term prognosis of children with symptoms suggestive of asthma at preschool age

https://doi.org/10.1016/j.jaci.2009.06.045Get rights and content

Background

Clinicians have difficulty in diagnosing asthma in preschool children with suggestive symptoms.

Objective

We sought to develop a clinical asthma prediction score for preschool children who have asthma-like symptoms for the first time.

Methods

The Prevalence and Incidence of Asthma and Mite Allergy birth cohort followed 3,963 children for 8 years. Between 0 and 4 years of age, 2,171 (55%) children reported “wheezing,” “coughing at night without a cold,” or both. In these children possible predictor variables for asthma were assessed at the age respiratory symptoms were first reported. Asthma was defined as wheezing, inhaled steroid prescription, or a doctor's diagnosis of asthma at both age 7 and 8 years of age.

Results

Eleven percent of children with symptoms at 0 to 4 years of age had asthma at 7 to 8 years of age. Eight clinical parameters independently predicted asthma at 7 to 8 years of age: male sex, postterm delivery, parental education and inhaled medication, wheezing frequency, wheeze/dyspnea apart from colds, respiratory infections, and eczema. In 72% of the cases, the model accurately discriminated between asthmatic and nonasthmatic children. A clinical risk score was developed (range, 0-55 points). Symptomatic children with a score of less than 10 points had a 3% risk, whereas children with a score of 30 points or greater had a 42% risk of asthma.

Conclusion

A risk score based on 8 readily available clinical parameters at the time preschool children first reported asthma-like symptoms predicted the risk of asthma at 7 to 8 years of age.

Section snippets

Study population

Recruitment took place in 1996-1997. A screening questionnaire was distributed to 10,232 pregnant women who attended one of 52 prenatal clinics in The Netherlands. Based on this screening, 7,862 women (2,779 allergic and 5,083 nonallergic women) were invited to participate in the study; 4,146 agreed and provided written informed consent. Questionnaires for parental completion, partly based on the International Study of Asthma and Allergies in Childhood core questionnaires,9 were sent to the

Study population

Of the 4,146 included mothers, 183 (4.5%) dropped out before returning the first postnatal questionnaire for various reasons (eg, stillbirth, language barrier, not interested, and moved). Of the 3,963 remaining children, 2,171 (55%) reported an episode of wheezing, coughing at night, or both between the ages of 0 and 4 years. Because only those children with early symptoms were eligible, the population for the present analysis consisted of 2,171 children. In more than half of the children,

Discussion

In this study we developed a prediction rule for the risk of asthma at 8 years of age to be used when preschool children present with symptoms suggestive of asthma for the first time. From a large prospective database, we identified 8 easily obtainable clinical parameters that best characterized the risk of asthma at 7 to 8 years of age.

Algorithms to predict the development of asthma in children have been reported previously. However, differences in design and analysis should be considered when

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    Supported by the Netherlands Organisation for Health Research and Development; the Netherlands Organisation for Scientific Research; the Netherlands Asthma Fund; the Netherlands Ministry of Spatial Planning, Housing, and the Environment; and the Netherlands Ministry of Health, Welfare and Sport. The salary of D. C. was paid by a “Toptalent” grant from Netherlands Organisation for Scientific Research (NWO).

    Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

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