The necessity of having asthma predictive scores in children

Abstract

Which infants and preschoolers with recurrent wheezing will have asthma once they have reached school age? This question is very important because asthma is one of the most prevalent chronic diseases in children; however, it is also one of the most difficult disorders for physicians to diagnose in infants and preschoolers. Approximately 40% of all young children worldwide have at least 1 episode of asthma symptoms, such as wheezing, coughing, or dyspnea. Moreover, approximately 80% of asthmatic patients have the disease in the first years of life. Fortunately, only 30% of preschoolers with recurrent wheezing still have asthma at age 6 years. In this issue of the Journal, Hafkamp-de Groen et al present information for validating (discrimination and calibration) and updating (or improving) the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) risk score for predicting asthma at 6 years of age. The authors studied 2877 preschoolers with asthma-like symptoms in Generation R (amultiethnic prospective population based cohort in TheNetherlands) and used the PIAMA risk score (a score developed in the PIAMA study, a prospective cohort of 3963 children followed from birth to 7-8 years of age in The Netherlands). The original PIAMA risk score has 8 predictors: male sex, postterm delivery, parental education, parental inhaled medication, wheezing/dyspnea apart from colds, wheezing frequency, presence of respiratory tract infection, doctor’s diagnosis of eczema (ever), and presence of eczematous rash. The study reported that the discriminative ability of the original PIAMA risk score to predict asthma in Generation R was moderate and similar compared with that in the PIAMA cohort (concordance index 5 0.74 vs 0.71). No differences in discriminative ability were found between different ages and ethnic and socioeconomic subgroups. For improving the score, the authors included preterm birth instead of the predictor postterm delivery and replaced parental inhalation medication for parental asthma. This updated PIAMA risk score had a slightly higher concordance index, sensitivity, and negative predictive value [NPV] versus the original risk score (0.75 vs 0.71, 64% vs 57%, and 97% vs 94%, respectively), but lower specificity