New symptom-based screening technique to detect asthma risk in children

ANI

Hamilton, October 7th

A team of researchers from the CHILD Cohort Study (CHILD) have developed a simple new symptom-based screening technique to detect asthma risk in children as young as two years old.

The effectiveness of the tool – the CHILDhood Asthma Risk Tool, or CHART – is detailed in a study published in the highly influential Journal of the American Medical Association (JAMA).

“Asthma affects nearly 330 million people worldwide, causes high health care costs and is the leading cause of hospitalization in children in Canada – particularly children under the age of five,” comments co-senior author Dr. Padmaja Subbarao, the Respirologist and CRC is the Tier 1 Chair in Pediatric Asthma and Lung Health at the Hospital for Sick Children (SickKids) and Director of CHILD. She is also a Professor in the Department of Pediatrics at the University of Toronto and an Associate Professor of Respirology and Medicine at McMaster University.

“Earlier detection of this condition will allow doctors to treat children earlier, so they suffer less and avoid hospitalizations, which also reduces costs to the healthcare system.” “One reason asthma in young children often goes undetected is because of this “Most conventional asthma tests in children are difficult to perform, time-consuming, invasive, and involve skin pricks and blood draws, leading many patients and physicians to choose to avoid them,” says the study, co-first author Myrtha E Reyna-Vargas, one M.Sc. and biostatistician at SickKids. “Other traditional tests can also require appointments with specialists and the use of specialized equipment to test lung function, with the associated costs.” CHART classifies children’s risk of future asthma and ongoing symptoms as “high,” “moderate,” or “low.” on, based on information reported before the age of three. The tool recommends follow-up actions for each group.

“The beauty of CHART, the new tool we have developed, is that it can be used by GPs or nurses in a resource-constrained primary care setting. It’s non-invasive; it can be done on-site and in-house It’s free and doesn’t require any special equipment. Now that we have demonstrated the benefits of CHART in the CHILD study, we are working to prospectively validate its use in clinical practice.” In the study, CHART was applied to data from 2,354 children enrolled in CHILD, one in 2008 launched a longitudinal research study tracking the prenatal physical, social and cognitive development of nearly 3,500 Canadian children.

Using information about the children’s wheezing and coughing fits, asthma medication use, and associated hospital visits by age three, CHART was able to predict with 91% accuracy which of these children would have persistent wheezing — a key indicator of asthma. -at the age of five.

Of the children who were at high risk of asthma by the age of three according to CHART, 50% were diagnosed with asthma by the study physicians by the age of five.

“We believe the tool is even more accurate than this number suggests at predicting asthma,” adds Dr. Malcolm Sears, co-author of the study, professor emeritus at McMaster University and founding director of CHILD.

“Because of various ambiguities in the way asthma is defined clinically, it is likely that some of these young children have asthma that is not formally diagnosed. And regardless of an official asthma diagnosis, persistent wheezing symptoms have been linked to chronic lower pulmonary disease and the same type of healthcare as asthma; persistent wheezing also requires similar monitoring and treatment, so the value of the tool’s predictive ability is undeniable. Overall, CHART was found to be more accurate in predicting persistent wheezing, asthma, and associated health care utilization than other standard diagnostic methods, including physician assessments and the traditional asthma test known as the modified asthma predictive index (mAPI).

The results of the study using CHILD data were also validated by comparing the performance of CHART to data from two additional cohort studies: the Canadian CAPPS cohort, all of whose participants are at high risk of asthma, and the Australian Raine study for the general population. Not only did CHART perform well within these cohorts, but — thanks to the data available through the CAPPS cohort — it has been shown to be effective when applied to data from children as young as two years of age.

“We developed CHART as a pragmatic screening tool for busy general practitioners,” says study co-first author Ruixue (Vera) Dai, an M.Sc. and biostatistician at SickKids.

“With information that can be easily collected, CHART could be integrated into electronic medical records as a routine assessment. These children can then be screened more closely, their illnesses better treated and managed, and many hospitalizations avoided.” “To our knowledge, this is the first study to develop a non-invasive tool for the early detection of asthma and persistent wheezing in a general population and which was subsequently validated in general and high-risk cohorts.”