New simple technique may help Primary caregivers identify asthma risk in young kids: CHART TRIAL

CANADA: An easy-to-use new symptom-based screening tool that can identify the risk of asthma in children as young as two years of age has been created by a research team working with the CHILD Cohort Study (CHILD). The results were brought to light in JAMA Network Open.

The authors emphasized that earlier detection of kids at risk for asthma should encourage active disease monitoring and therapeutic strategies.

Co-senior author Dr. Padmaja Subbarao further said, "Asthma affects almost 330 million people worldwide, bears a high healthcare cost, and is the leading cause of hospitalization among kids in Canada-especially youngsters under five.

According to the experts, wheezing affects up to 50% of all children in their early years. By the time they enter elementary school, wheezing is gone in around half of preschoolers. The Asthma Predictive Index or its modified version (mAPI), the Persistent Asthma Predictive Score, Predicting Asthma Risk in Children, or the Pediatric Asthma Risk Score are some of the current asthma prediction methods. These diagnostics, however, are worthless in a primary care context and some call for invasive procedures like blood or allergy skin prick testing.

The researchers sought to To create and assess a tool that uses symptoms to identify children who are at high risk for asthma, chronic wheezing symptoms, and medical expense.

The cohort for this diagnostic study included members from the CHILD Study (n = 2511) from January 1, 2008, to December 31, 2012, the Raine Study (n = 2185) from January 1, 1989, to December 31, 2012, and the Canadian Asthma Primary Prevention Study (CAPPS) from January 1, 1989, to December 31, 1995 (n = 349) with active follow-up to date. Data analysis was done between November 1, 2019, and May 31, 2022. The CHILDhood Asthma Risk Tool (CHART) identified factors linked to asthma in patients at 3 years of age (timing and frequency of wheeze or cough episodes, use of asthma medications, and emergency department visits or hospitalizations for asthma or wheeze) to identify kids with asthma or persistent symptoms at 5 years of age. The mAPI and CHART were compared with specialized clinician diagnoses within the CHILD Study group. Both a high-risk cohort and a general population cohort (Raine Study [Australia]) underwent external validation (CAPPS [Canada]). Sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), and positive and negative projected values were used to gauge predictive accuracy.

Key highlights of the study:

• With an area under the receiver operating characteristic curve (AUROC) of 0.94 (95% CI 0.90-0.97), CHART performed best for predicting chronic wheeze by age 5.
• It fared better (sensitivity 91.1% vs. 62.0% and 48.5%) than clinician diagnosis and the mAPI.
• The specificity and negative predictive value of all three prediction types were comparable, but mAPI had the best positive predictive value (PPV; 60.0% vs. 43.4% with CHART).
• CHART performed best for predicting emergency room visits or hospitalization for wheeze or asthma (AUROC 0.70, sensitivity 45.5% versus 25.0% with mAPI and 34.4% for physicians) as well as asthma diagnosis at age 5 (AUROC 0.73, sensitivity 50.0% vs 24.4% with mAPI and 43.5% for physicians).
• When compared to the Pediatric Asthma Risk score, CHART fared similarly.

"CHART is developed as a pragmatic screening tool to help busy primary care clinicians detect the small number of children at high risk for chronic wheezing (7% in our cohort) among all children who report wheeze (42% at any time point)," the researchers wrote in their conclusion.

REFERENCE

Reyna ME, Dai R, Tran MM, et al. Development of a Symptom-Based Tool for Screening of Children at High Risk of Preschool Asthma. JAMA Netw Open. 2022;5(10):e2234714. doi:10.1001/jamanetworkopen.2022.34714