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Individual risk assessment tool for school‐age asthma prediction in UK birth cohort
Author(s) -
Wang Ran,
Simpson Angela,
Custovic Adnan,
Foden Phil,
Belgrave Danielle,
Murray Clare S.
Publication year - 2019
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.13319
Subject(s) - wheeze , asthma , medicine , logistic regression , pediatrics , cohort , cohort study , respiratory sounds , population , allergy , immunology , environmental health
Summary Background Current published asthma predictive tools have moderate positive likelihood ratios (+ LR ) but high negative likelihood ratios (− LR ) based on their recommended cut‐offs, which limit their clinical usefulness. Objective To develop a simple clinically applicable asthma prediction tool within a population‐based birth cohort. Method Children from the Manchester Asthma and Allergy Study ( MAAS ) attended follow‐up at ages 3, 8 and 11 years. Data on preschool wheeze were extracted from primary‐care records. Parents completed validated respiratory questionnaires. Children were skin prick tested ( SPT ). Asthma at 8/11 years (school‐age) was defined as parentally reported (a) physician‐diagnosed asthma and wheeze in the previous 12 months or (b) ≥3 wheeze attacks in the previous 12 months. An asthma prediction tool ( MAAS APT ) was developed using logistic regression of characteristics at age 3 years to predict school‐age asthma. Results Of 336 children with physician‐confirmed wheeze by age 3 years, 117(35%) had school‐age asthma. Logistic regression selected 5 significant risk factors which formed the basis of the MAAS APT : wheeze after exercise; wheeze causing breathlessness; cough on exertion; current eczema and SPT sensitisation(maximum score 5). A total of 281(84%) children had complete data at age 3 years and were used to test the MAAS APT . Children scoring ≥3 were at high risk of having asthma at school‐age ( PPV > 75%; + LR 6.3, − LR 0.6), whereas children who had a score of 0 had very low risk( PPV 9.3%; LR 0.2). Conclusion MAAS APT is a simple asthma prediction tool which could easily be applied in clinical and research settings.