Noninvasive tool identifies 3-year-olds at high risk of asthma

A non-invasive, validated, symptom-based screening tool identified children at high risk for asthma at age 3, according to a study published in . JAMA network open.

Primary care settings can incorporate tools that trigger timely treatment initiatives and facilitate active disease monitoring, researchers say.

“Despite most adult asthma patients reporting symptoms beginning before school age, health professionals have no easy way to identify children at risk for chronic symptoms before school age. .” Myrtha E.Reina– miserable,master’s degree, a biostatistician, and Padmaja Subbarao, MD, MSc, A pediatric clinician and scientist at a hospital in Toronto told Healio in a statement.

Myrtha E.Reina– miserable,master’s degree,

“We wanted to simplify the identification of at-risk children in primary care so that doctors could evaluate these children and begin treatment sooner,” they said.

The CHILDhood Asthma Risk Tool (CHART) uses the timing and number of wheezing or coughing episodes, asthma medication use, ED visits or hospitalization at 3 years of age to assess increased risk of asthma or persistent symptoms at age. , medium, or low children. 5 years.

The study included 2,511 children (mean age 3.08 years, standard deviation 0.17, 52.7% boys, 64.9% ) participated, including 2,354 (93.7%) who had available outcome data at age 5 years.

At 3 years of age, 16.5% of children reported wheezing, 53.1% had 2 or more episodes, and 77.7% had wheezing. use of asthma medications10% of all were diagnosed with asthma.

research result

At age 3 years, CHART classified 178 (7.1%) children as high risk for asthma, 597 (23.8%) as intermediate risk, and 1,736 (69.1%) as low risk. This includes her 57 children who were deemed high-risk not identified by doctors.

Of the 220 children who had 2 or more episodes of wheezing at age 3, 79 (35.9%) still had wheezing at age 5. Of those, CHART classified 72 (91.1%) as high risk (area under the receiving operator curve). [AUROC]0.94; 95% CI, 0.9-0.97), compared with 49 (62%) classified as high risk by investigators (AUROC, 0.79; 95% CI, 0.74-0.85) (AUROC, 0.79; 95% CI, 0.74-0.85), 33 ( 48.5%) including those missed by CHART, according to a modified version of the asthma predictive index (mAPI; AUROC, 0.74; 95% CI, 0.68-0.8).

Sensitivity for detecting true-positive asthma at age 5 years based on symptoms from age 3 years ranged from 50% (AUROC, 0.73; 95% CI, 0.69-0.77) for CHART to 43.5% (AUROC, 0.77 ) ranged from 95% CI, 0.73–0.81), 41.7% for parent reports of surgeon-diagnosed asthma, and 24.4% for mAPI (AUROC, = 0.62; 95% CI, 0.568–0.65).

Of the 367 children who currently report asthma medication use, or ED visit or hospitalization At age 3 years, CHART classified 178 (48.5%) as high risk and recommended follow-up assessments after 6 to 12 months for the rest. CHART had the highest sensitivity to predict healthcare use at age 5 (45.5%; AUROC, 0.7; 95% CI, 0.61-0.78), standardized mAPI (25%), investigative physician (36.4 %), followed by an outside physician. Doctor’s diagnosis (34.4%).

The researchers found that CHART continued to demonstrate high sensitivity and AUROC compared to skin prick test data, and that blood eosinophil levels recorded at 1 year of age supported CHART in diagnosing asthma or persistent wheezing. I noticed that it didn’t improve performance.

In an analysis using an external cohort, among 2,185 children aged 5 years from the general population, including the Raine study (AUROC, 0.82; 95% CI, 0.79–0.86), and 349 high-risk children, CHART was shown to yield similar results for predicting persistent wheezing. age 7 years in the Canadian Asthma Primary Prevention Study (AUROC, 0.87; 95% CI, 0.8–0.94).

chart performance

Padmaja Subarao

Reyna-Vargas and Subbarao said:

Noting that CHART relies on information that health care providers can easily gather through interviews and questionnaires from parents in primary care and low-resource settings, the researchers suggest their tool may be more useful than others. said it is as good or better at identifying children at increased risk of asthma than tools. Tests that include methods that require more invasive means.

“Physicians need a simple, standardized approach to flag children at high risk for asthma. Tools like CHART are ideal because they allow parents to directly record symptoms every six months. It’s timely and helps busy clinicians focus on detailed follow-up of this small group of patients,” said Reyna-Vargas and Subbarao.

By improving the identification and routine use of tools, providers can facilitate timely treatment management, improve quality of life and reduce the clinical and financial burden of asthma, researchers continued. .

In the meantime, the researchers intend to continue their research.

Rayna-Vargas and Subbarao say, “We need to test the use of this tool in a real-world setting to evaluate its performance and see if it matches our cohort observational studies.” .

For more information:

Myrtha E.Reina– miserable,master’s degree, When Padmaja Subbarao, MD, MSc, Pediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G1X8.