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Predicting asthma in preschool children with asthma symptoms: study rationale and design
Esther Hafkamp-de Groen1, Hester F Lingsma, Daan Caudri
1The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands. e.hafkamp@erasmusmc.nl
Insights
This study validates and updates the PIAMA Risk Score to predict childhood asthma. The new Asthma Risk Appraisal Tool will help distinguish high-risk preschool children for better asthma management.
Area of Science:
- Pediatric respiratory health
- Epidemiology of childhood asthma
Background:
- Predicting school-age asthma in preschoolers with symptoms is challenging.
- The PIAMA (Prevention and Incidence of Asthma and Mite Allergy) Risk Score uses preschool parameters to predict school-age asthma.
- External validation and updating of the PIAMA Risk Score are needed.
Purpose of the Study:
- To externally validate and update the PIAMA Risk Score.
- To develop an Asthma Risk Appraisal Tool for predicting school-age asthma in preschoolers with symptoms.
- To test the implementation of this tool in well-child care settings.
Main Methods:
- Utilizing the prospective, multi-ethnic Generation R cohort (7893 children).
- Assessing the PIAMA Risk Score at preschool age to predict school-age asthma.
- Evaluating predictive ability by adding/removing predictors and assessing discrimination (C-index) and calibration.
- Conducting a pilot study for tool implementation in well-child care.
Main Results:
- The study aims to validate and potentially improve the PIAMA Risk Score's predictive accuracy for school-age asthma.
- An updated risk score will be developed into a user-friendly Asthma Risk Appraisal Tool.
- A pilot study will assess the feasibility of implementing the tool in clinical practice.
Conclusions:
- The Asthma Risk Appraisal Tool can aid well-child care providers in identifying preschool children at high or low risk for developing asthma.
- This research will enhance understanding of the PIAMA risk score's validity and improve asthma risk assessment for symptomatic preschoolers.
Background:
In well-child care it is difficult to determine whether preschool children with asthma symptoms actually have or will develop asthma at school age. The PIAMA (Prevention and Incidence of Asthma and Mite Allergy) Risk Score has been proposed as an instrument that predicts asthma at school age, using eight easy obtainable parameters, assessed at the time of first asthma symptoms at preschool age. The aim of this study is to present the rationale and design of a study 1) to externally validate and update the PIAMA Risk Score, 2) to develop an Asthma Risk Appraisal Tool to predict asthma at school age in (specific subgroups of) preschool children with asthma symptoms and 3) to test implementation of the Asthma Risk Appraisal Tool in well-child care.
Methods And Design:
The study will be performed within the framework of Generation R, a prospective multi-ethnic cohort study. In total, consent for postnatal follow-up was obtained from 7893 children, born between 2002 and 2006. At preschool age the PIAMA Risk Score will be assessed and used to predict asthma at school age. Discrimination (C-index) and calibration will be assessed for the external validation. We will study whether the predictive ability of the PIAMA Risk Score can be improved by removing or adding predictors (e.g. preterm birth). The (updated) PIAMA Risk Score will be converted to the Asthma Risk Appraisal Tool- to predict asthma at school age in preschool children with asthma symptoms. Additionally, we will conduct a pilot study to test implementation of the Asthma Risk Appraisal Tool in well-child care.
Discussion:
Application of the Asthma Risk Appraisal Tool in well-child care will help to distinguish preschool children at high- and low-risk of developing asthma at school age when asthma symptoms appear.This study will increase knowledge about the validity of the PIAMA risk score and might improve risk assessment of developing asthma at school age in (specific subgroups of) preschool children, who present with asthma symptoms at well-child care.
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