Researchers have developed a simple noninvasive screening tool they believe may help identify the likelihood of developing high-risk asthma in children as young as 2 years old, according to recent research published in JAMA Network Open. 

Using the CHILDhood Asthma Risk Tool (CHART), Myrtha E. Reyna, MSc, of the department of pediatrics at The Hospital for Sick Children in Toronto, Ontario, Canada, and colleagues found the screening tool better identified children 3 years and older with persistent wheeze at greater risk for developing asthma overall compared to physician assessment or the modified Asthma Predictive Index (mAPI). 

Researchers evaluated asthma predictive factors in CHART such as timing of wheeze, number of wheeze or cough episodes, inhaled or oral corticosteroid use, inhaled bronchodilator use, and hospitalizations or emergency department visits for asthma and wheeze. Children were considered high risk if they had at least two episodes of wheeze within 1 year together with a hospital or emergency department visit, frequent dry cough, or use of asthma medication. Low risk children were classified as having episodes of cough or one episode of wheezing prior to the last 12 months. The CHART predictions were compared against specialist clinician diagnosis and the mAPI.

Ms. Reyna and colleagues used CHART to assess factors associated with asthma in 2,511 children from the CHILD Study who were enrolled between January 2008 and December 2012, 2,185 children from the Raine Study between January 1989 and December 2012, 349 children from the Canadian Asthma Primary Prevention Study between January 1989 and December 2012. The children enrolled were evaluated at 3 years old except for in the Canadian study where children were deemed high risk and assessed at 2 years old. 

In the CHILD Study, the results showed CHART better predicted persistent wheeze at 5 years old compared with physician assessment and the mAPI (area under the receiving operator curve = 0.94; 95% CI, 0.90–0.97) as well as in diagnosis of asthma (AUROC = 0.73; 95% CI, 0.69–0.77) and predicting visits to the hospital or emergency department (AUROC = 0.70; 95% CI, 0.61–0.78). The results were similar for CHART predicting persistent wheeze at 5 years old better than physician assessment and mAPI in the Raine Study cohort (AUROC = 0.82; 95% CI, 0.79–0.86) and the Canadian cohort (AUROC = 0.87; 95% CI, 0.80–0.94) at 7 years old.

The researchers noted there is a high burden of asthma in children of preschool age and better primary care tools for identifying asthma are needed. “The tool could potentially be implemented routinely as part of electronic medical records initiated at infancy as a simple, noninvasive screening tool for children at primary care,” they concluded. 

Disclosures: Some authors declared financial ties to drugmakers. See full study for details. This study was funded in part by CIHR; Allergy, Genes and Environment Network of Centers of Excellence; Don and Debbie Morrison; Women’s and Children Health Research Institute; and Canada Research Chairs.