Simple primary care screening tool predicts asthma diagnosis in preschool children

A symptom-based screening tool used in primary care settings accurately identified children at high risk of asthma as young as 3 years old, according to results published online in JAMA network open.

Earlier identification of these at-risk children could encourage active disease surveillance, symptom control and treatment interventions, and potentially reduce use of costly health services, study authors from Canada and Australia write.

As context for their research, the authors note that wheezing, a primary defining feature of asthma, is common in early childhood and is reported in up to 50% of all children. However, the use of wheezing to diagnose childhood asthma is controversial because about half of preschool children who experience the symptom resolve it by school age. Nonetheless, early persistence of wheezing symptoms independent of remission has been associated with reduced lung function and chronic lung disease.

The use of current asthma-predicting tools in primary care is limited, the researchers explain, because many require invasive tests, such as blood or allergy skin prick testing. Other tools have been developed based on populations of children predisposed to asthma or have not been validated in the general population.

The use of current asthma prediction tools in primary care is limited because many require invasive testing, such as B. Blood or allergy skin prick tests. Other tools have been developed based on populations of children predisposed to asthma or have not been validated in the general population.

‘…novel, pragmatic and inexpensive screening tools that allow earlier identification of children at high risk of asthma are needed as a first step in busy primary care practices,’ say the researchers.

The original data used to develop their tool, the CHILDhood Asthma Risk Tool (CHART), came from the Canadian CHILD study with the goal of developing a symptom-based screening tool that children as young as 3 years old could use high risk can be identified as asthma, persistent wheezing and health burden at age 5 years.

The CHILD study (January 1, 2008 and December 31, 2012) included offspring of 3224 women who regularly completed child health questionnaires until one child was 5 years old; Children attended the clinic at the age of 1, 3 and 5 years.

DIAGRAM identified factors associated with asthma in patients as young as 3 years of age (timing and number of wheezing or coughing episodes, use of asthma medications, including corticosteroids and inhaled bronchodilators, and visits to the emergency department or hospitalizations for asthma or wheezing) to children with asthma or to identify persistent asthma symptoms by age 5 years.

Within the CHILD study cohort, CHART was assessed by specialist diagnosis and by the modified Asthma Predictive Index (mAPI).

External validation of CHART was performed using 2 specific cohorts: the Australian General Population Health Study Raine (n=2185) at age 5 and the Canadian Asthma Primary Prevention Study (CAPPS) (n=349), a cohort of high-risk children aged 7 and older years.

RESULTS

Of 2511 children in the CHILD study with sufficient questionnaire data to use CHART at age 3 years, 2354 (93.7%) had outcome data available at age 5 years. The mean age of the cohort at the 3-year hospital visit was 3.08 years and the group consisted of 52.7% boys.

In the CHILD group at 3 years of age, CHART performed better than clinical assessments and the mAPI in predicting persistent wheezing (area under the characteristic receiver operating curve [AUROC]), 0.94; 95% CI, 0.90-0.97), asthma diagnosis (AUROC, 0.73; 95% CI, 0.69-0.77), and health care utilization (emergency department visits or hospitalization for wheezing or asthma) ( AUROC, 0.70, 95% CI, 0.61-0.78).

Of particular note, the authors say that CHART provides the highest predictive capacity for later health care utilization at age 5, identifying 20% ​​more children with emergency department visits or hospitalizations than the mAPI (sensitivity, 45.5% vs. 25.0%) and approximately 10% more than the study physician (sensitivity, 36.4%) and the external physician’s diagnosis (34.4%).

Of particular note, the authors say that CHART provides the highest predictive capacity for later health care utilization at age 5, identifying 20% ​​more children with emergency department visits or hospitalizations than the mAPI (sensitivity, 45.5% vs. 25.0%) and approximately 10% more than the study physician (sensitivity, 36.4%) and the external physician’s diagnosis (34.4%).

CHART predictive performance for persistent wheezing was similar in the Raine study of the general population in children aged 5 years and in the high-risk CAPPS population aged 7 years.

CHART targets information that can be readily gathered by health professionals through interviews or parent-reported questionnaires in primary care or in resource-poor settings, the authors write, and allows for the identification of high-risk children for additional testing and such with moderate or low risk. Risk for regular monitoring.

Researchers noted: “CHART is designed as a pragmatic screening tool to help busy primary care physicians identify the small proportion of children at high risk of persistent wheezing (7% in our population) among all children who report wheezing.” (42% point at any point).”

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

“To our knowledge, this is the first study to develop a non-invasive tool for early detection of asthma and persistent wheezing in a general population, which was subsequently validated in general and high-risk cohorts,” they conclude.

Reference: Reyna ME, Dai R, Tran MM, et al. Development of a symptom-based tool to screen high-risk preschool children with asthma. JAMA network open. 2022;5:e2234714. doi:10.1001/jamanetworkopen.2022.34714