Predicting asthma in preschool children with asthma-like symptoms

Published Online: August 28, 2013

Parents of preschool children with asthma-like symptoms, such as wheezing or dry cough, are often interested if their child will have persistent asthma at a later age. It is known that approximately 30% of preschool wheezing children have asthma at school age. Preschool asthma-like symptoms are non-specific, and therefore it is difficult to determine which preschool children with asthma-like symptoms actually have or will develop asthma at school age. Several asthma prediction models have been proposed to improve early diagnosis and management of asthma-like symptoms. The PIAMA Risk Score predicts the probability of developing asthma at school age among preschool children with suggestive symptoms.

A recent study published in The Journal of Allergy & Clinical Immunology (JACI), by Hafkamp-de Groen et al, externally validated and updated the PIAMA Risk Score. They used data collected on 2,171 children with preschool asthma-like symptoms participating the PIAMA study (development study) and 2,877 children with preschool asthma-like symptoms, participating in the multi-ethnic prospective population-based cohort study, Generation R (validation study).

At age 6 years, 6% (168/2,877) of the children had developed asthma. Compared to the development study, the original PIAMA Risk Score was able to better distinguish asthmatic from non-asthmatic children. No differences in the ability of the original PIAMA Risk Score to distinguish asthmatic from non-asthmatic children were found at different ages or in ethnic and socioeconomic subgroups of preschool children. The updated PIAMA Risk Score included pre-term birth (instead of post-term) and respiratory tract infections were removed from the original PIAMA Risk Score.

The authors concluded from these results that the original PIAMA Risk Score showed good external validity in a multi-ethnic cohort study. The authors recommend that further studies are needed to reproduce the predictive performance of the updated PIAMA Risk Score in other populations and settings, and to assess its clinical relevance.


The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

AAAAI - American Academy of Allergy Asthma & Immunology