The Journal of Allergy and Clinical Immunology
Volume 124, Issue 5 , Pages 903-910.e7 , November 2009

Predicting the long-term prognosis of children with symptoms suggestive of asthma at preschool age

  • Daan Caudri, MD

      Affiliations

    • Department of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
  • ,
  • Alet Wijga, PhD

      Affiliations

    • Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  • ,
  • C. Maarten A. Schipper, PhD

      Affiliations

    • Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
  • ,
  • Maarten Hoekstra, MD, PhD

      Affiliations

    • Centre for Paediatric Allergology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
  • ,
  • Dirkje S. Postma, MD, PhD

      Affiliations

    • Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  • ,
  • Gerard H. Koppelman, MD, PhD

      Affiliations

    • Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  • ,
  • Bert Brunekreef, MD, PhD

      Affiliations

    • Institute for Risk Assessment Sciences and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  • ,
  • Henriette A. Smit, PhD

      Affiliations

    • Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  • ,
  • Johan C. de Jongste, MD, PhD

      Affiliations

    • Department of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
    • Corresponding Author InformationReprint 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.

Received 10 March 2009 ,Revised 7 May 2009 ,Accepted 23 June 2009.

  • Image Result

    Predicted risk of asthma development at 7 to 8 years of age by prediction score.

    Predicted risk of asthma development at 7 to 8 years of age by prediction score.

  • Image Result

    Predicted and observed risk of asthma development at 7 to 8 years of age per prediction score category. The number of children observed per category is shown in brackets. Expected risk is estimated by

    Predicted and observed risk of asthma development at 7 to 8 years of age per prediction score category. The number of children observed per category is shown in brackets. Expected risk is estimated by using the average score per 5-point category. ∗Estimate for the merged category (≥35 points) is weighed by the number of children actually observed at each 5-point subcategory between 35 and 55 points.

  • Image Result
    Receiver operating characteristic curve of categorized prediction score on the outcome of asthma at 7 to 8 years of age. Cutoff values of prediction scores are reported in the curve (dots). The area u

    Receiver operating characteristic curve of categorized prediction score on the outcome of asthma at 7 to 8 years of age. Cutoff values of prediction scores are reported in the curve (dots). The area under the receiver operating characteristic curve (C-index) for the categorized score is 0.736 (before validation). Also, the sensitivity and specificity for a doctor's diagnosis of asthma at the age when symptoms were first reported (between 0 and 4 years) are displayed (square).

  • Image Result
    Proportion of children with asthma at 7 to 8 years of age explained by the proportion of children at highest risk according to the prediction score. Cutoff values of prediction scores are reported in

    Proportion of children with asthma at 7 to 8 years of age explained by the proportion of children at highest risk according to the prediction score. Cutoff values of prediction scores are reported in the curve (dots). Also, data for a doctor's diagnosis of asthma at the age when symptoms were first reported (between 0-4 years) are displayed (square).

  • Image Result
    The PIAMA birth cohort recruitment scheme.

    The PIAMA birth cohort recruitment scheme.

  • Image Result
    Flowchart of the study population. ∗Two thousand seven hundred seventy-nine allergic and 5,083 nonallergic mothers were invited, as determined before initiation of the study based on a power calculati

    Flowchart of the study population. ∗Two thousand seven hundred seventy-nine allergic and 5,083 nonallergic mothers were invited, as determined before initiation of the study based on a power calculation. Of the 4,146 women included in the study, the proportion of allergic women (31%) was very similar to that in the general Dutch population. †Symptoms were defined as a positive response to the following questions: “Has your child had wheezing or whistling in the chest in the last 12 months?,” “Has your child had cough during the night, when he/she did not have a cold or a chest infection, in the last 12 months?,” or both. Reasons for loss to follow-up included lack of motivation, illness of child, repeated nonresponse, moved, and personal reasons.

 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.

PII: S0091-6749(09)01011-2

doi: 10.1016/j.jaci.2009.06.045

The Journal of Allergy and Clinical Immunology
Volume 124, Issue 5 , Pages 903-910.e7 , November 2009