Predicting who will have asthma at school age among preschool children

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Clinical Epidemiology

Background:

• Distinguishing preschool wheezing from future asthma is difficult.
• Clinical prediction rules can aid prognosis and guide treatment/prevention strategies for childhood asthma.
• Accurate prediction of school-age asthma from preschool symptoms remains an unmet clinical need.

Purpose of the Study:

• To review the development and utility of clinical prediction rules for asthma in preschool children.
• To evaluate the European Respiratory Society Task Force classification of preschool wheeze.
• To assess the effectiveness of current prediction rules and recommend improvements for identifying children with future asthma.

Main Methods:

• Literature review of clinical prediction rules for childhood asthma.
• Analysis of the European Respiratory Society Task Force classification of preschool wheeze.
• Synthesis of evidence on the predictive value of current rules and proposed enhancements.

Main Results:

• Clinical prediction rules are increasingly developed but have limited clinical application.
• The classification of episodic and multiple-trigger wheeze shows conflicting results and limited predictive value for school-age asthma.
• Existing prediction rules for identifying future asthma in preschool children demonstrate modest clinical utility.

Conclusions:

• Current methods for predicting school-age asthma from preschool wheezing are of limited value.
• Improved asthma prediction requires more precise definitions, measures, and understanding of underlying mechanisms.
• Future advancements may involve biomarkers and genomic profiling for personalized asthma management.