New simple symptom-based screening tool detects asthma risk in young children

A team of researchers working with the CHILD Cohort Study (CHILD) has developed a new, simple symptom-based screening tool that detects asthma risk in children as young as two years old.

The effectiveness of the tool; the CHILDhood Asthma Risk Tool, or CHART; is detailed in a study published in the highly influential Journal of the American Medical Association (JAMA).

“Asthma affects nearly 330 million people worldwide, incurs heavy health care costs, and is the leading cause of hospitalizations among children in Canada, particularly children under five years of age,” comments the lead co-author, Dr. Padmaja Subbarao, who is a pulmonologist and CRC. Tier 1 Chair in Pediatric Asthma and Lung Health at the Hospital for Sick Children (SickKids) and Director of CHILD. She is also a Professor in the Department of Pediatrics at the University of Toronto and Adjunct Professor of Respirology and Medicine at McMaster University.

“Earlier detection of this disease will allow doctors to treat children earlier, so that they suffer less and avoid going to hospital, thus also reducing costs for the health system.”

“One of the reasons why asthma often goes unnoticed in young children is that most conventional asthma tests in children are difficult to perform, time consuming and invasive, involve skin pricks and blood, so many patients and physicians choose to avoid them,” the study notes. co-first author, Myrtha E Reyna-Vargas, M.Sc. and biostatistician at SickKids. “Other conventional tests may also require appointments with specialists and the use of specialized equipment to test lung function, with associated costs.”

CHART classifies the risk of future asthma and persistent symptoms in children as “high”, “moderate” or “low”, based on information reported before the age of three. The tool recommends follow-up actions for each group.

“The beauty of CHART, the new tool we’ve developed, is that it can be used by family doctors or nurses in a low-resource primary care setting. It’s non-invasive; it can be done on the spot. and – for now; it’s free and requires no special equipment. Now that we’ve demonstrated the benefits of CHART in the CHILD study, we’re working to validate its use prospectively in clinical practice.”

In the study, CHART was applied to data from 2,354 children participating in CHILD, a longitudinal research study launched in 2008 that followed the physical, social and cognitive development of nearly 3,500 Canadian children before birth.

Using information on children’s wheezing and coughing episodes, asthma medication use, and associated hospital visits by age three, CHART was able to predict with an accuracy of 91% which of these children would have persistent wheezing; a key indicator of asthma. ;at the age of five.

Of the children assessed by CHART as having a high risk of asthma at the age of three, 50% were diagnosed by the study doctors as having asthma at the age of five.

We think the tool is actually even more accurate at predicting asthma than this number suggests.”

Dr. Malcolm Sears, study co-lead author, professor emeritus at McMaster University and founding director of CHILD

“Due to various ambiguities in the clinical definition of asthma, it is likely that a number of these young children have asthma that remains formally undiagnosed. And regardless of an official diagnosis of asthma, the symptoms persistent wheezing has been linked to lower lung function, lung disease, and the same type of health care use as asthma; persistent wheezing also requires similar monitoring and treatment, so the value of the predictive capacity of the tool is indisputable.”

Overall, CHART was found to be more accurate in predicting persistent wheezing, asthma, and related health care utilization than other standard diagnostic methods, including physician assessments and blood pressure testing. conventional asthma known as the Modified Asthma Predictive Index (mAPI).

The results of the study using CHILD data were also validated by testing the performance of CHART against data from two additional cohort studies: the Canadian CAPPS cohort, whose participants are all at high risk of asthma, and the Raine study of the general Australian population. Not only did CHART also work well within these cohorts, but thanks to the data available through the CAPPS cohort, it was found to be effective when applied to data from children as young as two years old.

“We designed CHART to be a pragmatic screening tool for use by busy primary caregivers,” says study co-first author Ruixue (Vera) Dai, who holds an M.Sc. . and biostatistician at SickKids.

“With information that can be easily collected, CHART could be integrated into electronic medical records as a routine assessment. These children can then be more closely assessed, their conditions treated and better managed, and many hospitalizations can be avoided.”

“To our knowledge, this is the first study to develop a non-invasive tool for the early detection of asthma and persistent wheezing in a general population, and which has subsequently been validated in general cohorts and at high risk.”


Journal reference:

Reyna, me, et al. (2022) Development of a symptom-based tool for screening children at high risk for preschool asthma. JAMA network open.

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