Published Online: July 26, 2013
Many preschool children suffer from wheeze or chronic cough. These children may need visits to their doctor, are often hospitalized, and receive a variety of treatments. Fortunately, few of them develop chronic asthma at school-age. The others have transient problems, which gradually disappear. It is important to determine the risk a wheezy child will have of developing chronic wheeze, or whether the problems are likely to be transient. This can improve clinical decision-making, allow the right children to enter research studies and provide reliable prognostic advice to worried parents. Several tools for improving prediction of later asthma in such children have been developed. However, some of these tools are difficult to use in clinical practice, while others have methodological limitations.
In an original article in The Journal of Allergy and Clinical Immunology (JACI), Pescatore et al, present their new asthma prediction tool. They used data from 1-3 year old children from Leicestershire, UK, who had visited a doctor for wheeze or recurrent cough. Using information on symptoms at preschool-age, the authors developed a statistical model to predict presence of asthma 5 years later. The tool uses only information which can easily be collected in primary care and is non-invasive (i.e. does not rely on blood tests). In addition, the tool has been developed in a standardized way, avoiding limitations of previous similar approaches such as overfitting.
Of the 1,226 preschool children with wheeze or recurrent cough, in this study, only 345 (28%) had asthma 5 years later. The prediction tool consists of 10 items, giving a maximum score of 15. The items include: gender, age, parental history of asthma, eczema, wheeze apart from colds, frequent wheeze, wheeze disturbing daily activity, wheeze accompanied by shortness of breath, wheeze triggered by exercise, and wheeze triggered by inhaled allergens (house dust, pollen or furry pets). Despite being so simple, the tool performs similarly or better than previously published instruments.
In summary, the new tool represents a simple, low-cost and non-invasive method to predict the risk of later asthma in symptomatic pre-school children and is ready to be tested in other populations.
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.