title: A simple asthma prediction tool for preschool children with wheeze or cough.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Anina M
authors.initials: AM
authors.lastname: Pescatore
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Cristian M
authors.initials: CM
authors.lastname: Dogaru
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland.
authors.forename: Lutz
authors.initials: L
authors.lastname: Duembgen
authors.affiliation: Department of Infection, Immunity & Inflammation, University of Leicester, Leicester, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Silverman
authors.affiliation: Department of Infection, Immunity & Inflammation, University of Leicester, Leicester, United Kingdom.
authors.forename: Erol A
authors.initials: EA
authors.lastname: Gaillard
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Ben D
authors.initials: BD
authors.lastname: Spycher
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. Electronic address: kuehni@ispm.unibe.ch.
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Kuehni
mesh_terms: D000485:Allergens; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003371:Cough / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012135:Respiratory Sounds / Q000175:diagnosis*; D012306:Risk; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D000485:Allergens
keywords: API; AUC; Area under the receiver operating characteristic curve; Asthma; Asthma Predictive Index; LASSO; Least absolute shrinkage and selection operator; children; cohort study; cough; longitudinal; persistence; prediction; prognosis; wheeze