Asthma and lower airway disease
A simple asthma prediction tool for preschool children with wheeze or cough

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Background

Many preschool children have wheeze or cough, but only some have asthma later. Existing prediction tools are difficult to apply in clinical practice or exhibit methodological weaknesses.

Objective

We sought to develop a simple and robust tool for predicting asthma at school age in preschool children with wheeze or cough.

Methods

From a population-based cohort in Leicestershire, United Kingdom, we included 1- to 3-year-old subjects seeing a doctor for wheeze or cough and assessed the prevalence of asthma 5 years later. We considered only noninvasive predictors that are easy to assess in primary care: demographic and perinatal data, eczema, upper and lower respiratory tract symptoms, and family history of atopy. We developed a model using logistic regression, avoided overfitting with the least absolute shrinkage and selection operator penalty, and then simplified it to a practical tool. We performed internal validation and assessed its predictive performance using the scaled Brier score and the area under the receiver operating characteristic curve.

Results

Of 1226 symptomatic children with follow-up information, 345 (28%) had asthma 5 years later. The tool consists of 10 predictors yielding a total score between 0 and 15: sex, age, wheeze without colds, wheeze frequency, activity disturbance, shortness of breath, exercise-related and aeroallergen-related wheeze/cough, eczema, and parental history of asthma/bronchitis. The scaled Brier scores for the internally validated model and tool were 0.20 and 0.16, and the areas under the receiver operating characteristic curves were 0.76 and 0.74, respectively.

Conclusion

This tool represents a simple, low-cost, and noninvasive method to predict the risk of later asthma in symptomatic preschool children, which is ready to be tested in other populations.

Section snippets

Study population

We analyzed data from a population-based childhood cohort from Leicestershire, United Kingdom, that has been described in detail elsewhere.21, 22, 23 In brief, we recruited a representative population-based sample of 6808 children of white and South Asian ethnic origin born in 1993-1997. Perinatal data were collected at birth, and data on growth and development were acquired prospectively during childhood. Upper and lower respiratory morbidity, treatments and health care use, family history of

Study population

At the baseline survey, 5878 of 6808 children were aged 1 to 3 years. Fig 1 shows how many of the 1- to 3-year-old children reported episodes of wheeze, cough without colds, or cough at night in the past 12 months and in addition reported visits to a doctor (n = 2444), making them eligible for the study. For 1226 children, we had information on any asthma 5 years later. Their characteristics are shown in Table I for the variables selected by the main model and in Table E1 for all potential

Summary of findings

We have developed a new tool for predicting asthma at school age in preschool children who see a doctor for wheeze or cough. Our tool includes 10 predictors representing wheeze severity and triggers, male sex, age, eczema, and parental respiratory history. It showed good internal validity and is distinguished by ease of use in primary care and epidemiologic studies.

Comparison with previous prediction models

Several prediction models have been proposed for estimating the risk of persistent asthma in preschool children.8, 9, 10, 11, 12, 13

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  • Cited by (0)

    Supported by the Swiss National Science Foundation (PDFMP3-123162 and 3200B0-122341) and Asthma UK 07/048. B.D.S. is the recipient of a European Respiratory Society/Marie Curie Joint Research Fellowship (MC 1614-2010).

    Disclosure of potential conflict of interest: C. E. Kuehni has received grants from the Swiss National Science Foundation (SNF). M. Silverman has received grants from Asthma UK. B. D. Spycher has received grants from the European Respiratory Society/Marie Curie Actions Joint Research Fellowship. The rest of the authors declare that they have no relevant conflicts of interest.

    These authors contributed equally to this work.

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