Primary Care Screening Tool Accurately Predicts Lasting Asthma in Preschoolers

An international team of researchers found that a symptom-based screening tool used in primary care could accurately identify preschoolers at risk of persistent asthma symptoms and higher health care use.

Earlier identification of children at risk of asthma could promote active disease monitoring and treatment interventions, the authors noted, writing in JAMA Network Open.

Wheezing is common in early childhood, reported in up to 50% of all children, the researchers said. About half of preschool children with wheeze see it vanish by the time they reach elementary school.

Current asthma prediction tools include the Asthma Predictive Index or its modified version (mAPI), the Persistent Asthma Predictive Score, Predicting Asthma Risk in Children, or the Pediatric Asthma Risk Score. However, these tests are not useful in the primary care setting and some require invasive tests, such as blood or allergy skin prick tests.

Data for this study came from 3 cohorts:

• The Canadian CHILD Study (n = 2511), which ran from January 1, 2008, to December 31, 2012
• The long-running Australian population health study, Raine, (n = 2185), from January 1, 1989, to December 31, 2012
• The Canadian Asthma Primary Prevention Study (CAPPS), which ran from January 1, 1989, to December 31, 1995 (n = 349)

Researchers tested the CHILDhood Asthma Risk Tool (CHART) within the CHILD study group and evaluated it against the mAPI and a diagnosis made by a specialist.

External validation was performed in the Raine cohort and the CAPPS cohort, which had high-risk participants.

The authors said they believe this is the "first symptom-based preschool screening tool developed in a cohort of unselected individuals and validated in both general and high-risk cohorts."

CHART asked about factors linked with asthma, including timing and number of wheeze or cough episodes, use of asthma medications, and emergency department (ED) visits or hospitalizations for asthma or wheeze.

A little more than half of the children in the CHILD group were male, nearly 65% were White, and the mean age was 3.08. Almost 94% of the participants had outcome data at 5 years of age.

In the CHILD group, CHART performed better than clinician assessments and the mAPI in predicting persistent wheeze (area under the receiver operating characteristic curve [AUROC]), 0.94; 95% CI, 0.90-0.97), asthma diagnosis (AUROC, 0.73; 95% CI, 0.69-0.77), and health care use (ED visits or hospitalization for wheeze or asthma) (AUROC, 0.70; 95% CI, 0.61-0.78).

CHART had a similar predictive performance for persistent wheeze in the Raine Study in children at 5 years of age and CAPPS (N = 349) at 7 years of age.

The researchers noted, "CHART is designed as a pragmatic screening tool to help busy primary care clinicians identify the small proportion of children at high risk for persistent wheezing (7% in our population) among all children who report wheeze (42% at any time point)."

Once identified, children at a high risk of having persistent asthma should be further evaluated for both severity and endotype of asthma, the authors said.

Reference

Reyna ME, Dai R, Tran MM, et al. Development of a symptom-based tool for screening of children at high risk of preschool asthma. JAMA Netw Open. 2022;5(10):e2234714. doi:10.1001/jamanetworkopen.2022.34714