Predicting the long-term prognosis of children with symptoms suggestive of asthma at preschool age
Received 10 March 2009; received in revised form 7 May 2009; accepted 23 June 2009. published online 10 August 2009.
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.
aDepartment of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
bCentre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
cExpertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
dCentre for Paediatric Allergology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
eBeatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
fInstitute for Risk Assessment Sciences and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Reprint requests: Johan C. de Jongste, MD, PhD, Erasmus MC/Sophia Children's Hospital, Department of Pediatric Respiratory Medicine, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
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.
ABSTRACT