Article

Predicting asthma in preschool children at high risk presenting in primary care: development of a clinical asthma prediction score

  • Primary Care Respiratory Journal (2014) 23, 5259
  • doi:10.4104/pcrj.2014.00003
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Abstract

Background:

A setting-specific asthma prediction score for preschool children with wheezing and/or dyspnoea presenting in primary healthcare is needed since existing indices are mainly based on general populations.

Aims:

To find an optimally informative yet practical set of predictors for the prediction of asthma in preschool children at high risk who present in primary healthcare.

Methods:

A total of 771 Dutch preschool children at high risk of asthma were followed prospectively until the age of six years. Data on asthma symptoms and environmental conditions were obtained using validated questionnaires and specific IgE was measured. At the age of six years the presence of asthma was assessed based on asthma symptoms, medication, and bronchial hyper-responsiveness. A clinical asthma prediction score (CAPS) was developed using bootstrapped multivariable regression methods.

Results:

In all, 438 children (56.8%) completed the study; the asthma prevalence at six years was 42.7%. Five parameters optimally predicted asthma: age, family history of asthma or allergy, wheezing-induced sleep disturbances, wheezing in the absence of common colds, and specific IgE. CAPS scores range from 0 to 11 points; scores <3 signified a negative predictive value of 78.4% while scores of ≥7 signified a positive predictive value of 74.3%.

Conclusions:

We have developed an easy-to-use CAPS for preschool children with symptoms suggesting asthma who present in primary healthcare. After suitable validation, the CAPS may assist in guiding shared decision-making to tailor the need for medical or non-medical interventions. External validation of the CAPS is needed.

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Acknowledgements

Handling editor Niels Chavannes

Statistical review Gopal Netuveli

We would like to thank the general practitioners at HAG-net-AMC, Zorggroep Almere and Prinsenhof, Leemhuis, and Buitenhuis for their time and effort. We also thank all parents and children for participating in the study. Our thanks also go to Pauline van Steenwijk, Machteld IJff, Alice Karsten, and Albertien Buijs for their invaluable help with data collection and other logistics.

Funding This study was financially supported by the Netherlands Asthma Foundation (3.4.06.078) and Stichting Astma Bestrijding (2008/027).

Author information

Affiliations

  1. Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands

    • Lonneke B van der Mark
    • , Karina E van Wonderen
    • , Jacob Mohrs
    •  & Gerben ter Riet
  2. Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital — Academic Medical Center, Amsterdam, The Netherlands

    • Wim MC van Aalderen
  3. Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands

    • Patrick JE Bindels

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Contributions

LvdM was the lead investigator, participated in the design, coordinated the follow-up of the study, carried out all the statistical analyses, and drafted the manuscript. KEvW participated in the design, coordinated the follow-up of the study, and revised the manuscript critically. JM and WMCvA participated in preparing the data for statistical analysis and revised the manuscript critically. GtR participated in the design and coordination of the study, supervised it, participated in the statistical analysis, helped to draft the manuscript, and revised the manuscript critically. PJEB participated in the design of the study, supervised it, and revised the manuscript critically. All authors read and approved the final manuscript.

Competing interests

The authors declare that they have no conflicts of interest in relation to this article.

Corresponding author

Correspondence to Lonneke B van der Mark.

Appendices

Appendix 1. Supplementary material