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The Preschool Asthma Risk Factors Scale: A predictive tool for asthma and respiratory symptoms among preschool
Hallit Souheil1,2, Rahme Clara3, Sacre Hala4
1Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
Insights
The Preschool Asthma Risk Factor Scale (PS-ARFS) can predict asthma diagnosis in young children. An improved scale (PS-ARFS-I) and the original scale both predicted asthma at one year, with PS-ARFS also predicting respiratory symptoms.
Area of Science:
- Pediatric Allergy and Immunology
- Environmental Health
- Epidemiology
Background:
- The Preschool Asthma Risk Factor Scale (PS-ARFS) assesses environmental exposures, parental asthma history, and diet in preschool children.
- Evaluating the PS-ARFS's predictive accuracy for asthma diagnosis and respiratory symptoms one year post-assessment is crucial.
- The study aimed to validate and potentially improve the PS-ARFS for better clinical utility.
Purpose of the Study:
- To assess the predictive ability of the PS-ARFS for asthma diagnosis and respiratory symptoms in preschool children after one year.
- To refine the PS-ARFS based on study findings to enhance its predictive power.
Main Methods:
- A prospective cohort study involving 515 preschool children aged 3-5 years across three Lebanese regions.
- Baseline data (T0) collected via parental questionnaires, with follow-up surveys conducted one year later (T1) via telephone.
- Analysis included assessing associations between baseline factors and 1-year outcomes, leading to the development of an improved scale (PS-ARFS-I).
Main Results:
- Playing outside and bedroom heating systems at baseline were associated with higher odds of asthma diagnosis at 1 year.
- The improved PS-ARFS-I and the original PS-ARFS both significantly predicted asthma diagnosis at 1-year follow-up.
- The original PS-ARFS predicted wheezing and cough in non-asthmatic children at baseline, but the PS-ARFS-I did not predict symptoms at T1.
Conclusions:
- Both the PS-ARFS-I and PS-ARFS demonstrated predictive value for diagnosed asthma one year later.
- The PS-ARFS showed utility in predicting future respiratory symptoms like wheezing and cough among children without asthma at the start.
- Early assessment of risk factors using validated scales can aid in predicting later asthma development and symptoms.
Background:
The Preschool Asthma Risk Factor Scale (PS-ARFS) is a tool that enables clinicians to assess environmental exposure of preschool children, history of parental asthma, and dietary habits. The objective of this study was to evaluate the PS-ARFS ability to predict asthma diagnosis and respiratory symptoms 1 year after baseline assessment and improve the scale if necessary.
Methods:
A prospective cohort study conducted between November 2018 and March 2019 in three Lebanese schools (from three different Lebanese Governorates) enrolled 515 preschool children aged 3-5 years. Parents completed a detailed questionnaire sent with their children (Phase 1; T0). All parents who participated in Phase 1 were invited to take the same survey by telephone (Phase 2; T1), 1 year later. The interview was conducted by one study-independent person. Of the total sample, 141 (27.4%) children were lost to follow-up.
Results:
Higher odds of asthma diagnosis at 1 year were significantly associated with playing outside (adjusted odds ratio [aOR] = 3.958) and having a heating system in the bedroom (aOR = 6.986) at baseline, but inversely associated with the female gender (aOR = 0.365). Based on those results, the improved PS-ARFS-I was generated. A higher PS-ARFS-I at T0 was significantly associated with higher odds of asthma at T1 (aOR = 1.08; p < 0.001; 95% confidence interval [CI] 1.05-1.10); similar results were obtained with the longer PS-ARFS (aOR = 1.079; p < 0.001; 95% CI 1.050-1.109). Moreover, among non-asthmatic children at baseline, the PS-ARFS score predicted wheezing and cough at T1 but not bronchial secretions; the PS-ARFS-I score at baseline did not predict symptoms at T1.
Conclusion:
This study shows that the PS-ARFS-I and PS-ARFS could predict diagnosed asthma at 1-year follow-up. The PS-ARFS predicted respiratory symptoms (wheezing and cough) after 1 year among non-asthmatic children at baseline, suggesting that a score based on risk factors, measured early on, can predict better later symptoms and disease.
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