A simple asthma prediction tool for preschool children with wheeze or cough

• Published in: Journal of allergy and clinical immunology Vol. 133; no. 1; pp. 111 - 118.e13
• Main Authors: Pescatore, Anina M., Dogaru, Cristian M., Duembgen, Lutz, Silverman, Michael, Gaillard, Erol A., Spycher, Ben D., Kuehni, Claudia E.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.01.2014; Elsevier; Elsevier Limited
• Subjects: Age; Allergens; Allergy and Immunology; Asthma; Asthma - diagnosis; Asthma - epidemiology; Biological and medical sciences; Child; Child, Preschool; children; Children & youth; Chronic obstructive pulmonary disease, asthma; Cohort Studies; cohort study; cough; Cough - diagnosis; Cough - epidemiology; Families & family life; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Infant; longitudinal; Male; Medical sciences; persistence; Pneumology; Population; prediction; Prevalence; Primary care; Prognosis; Questionnaires; Respiratory Sounds - diagnosis; Risk; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Surveys and Questionnaires; United Kingdom; wheeze; cohort study; wheeze; children; LASSO; prediction; persistence; API; longitudinal; cough; prognosis; Asthma; AUC; Least absolute shrinkage and selection operator; Asthma Predictive Index; Area under the receiver operating characteristic curve; Human; Preschool age; Lung disease; Immunopathology; Prognosis; Respiratory disease; Prediction; Wheezing; Cough; Persistence; Immunology; Cohort study; Bronchus disease; Obstructive pulmonary disease; Predictive factor; Child
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2013.06.002

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