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


CONCLUSIONS
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.
Caudri
Daan
D
Department of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands.
Wijga
Alet
A
A Schipper
C Maarten
CM
Hoekstra
Maarten
M
Postma
Dirkje S
DS
Koppelman
Gerard H
GH
Brunekreef
Bert
B
Smit
Henriette A
HA
de Jongste
Johan C
JC
D000485:Allergens / Q000276:immunology; D000818:Animals; D001249:Asthma / Q000453:epidemiology* / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D039981:Pyroglyphidae / Q000276:immunology*; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000485:Allergens