Researchers have developed a new app that may help clinicians predict which children are at mild to moderate risk of developing asthma, compared with previous assessments that were only able to identify higher-risk patients.
The assessment, called the Pediatric Risk Asthma Score (PARS), was developed by researchers at the University of Cincinnati and Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, Ohio, and published in the Journal of Asthma and Clinical Immunology.1 Coauthor of the report Gurjit K. Khurana Hershey, MD, PHD, Kindervelt Endowed Chair in Asthma Research, professor of Pediatrics, director of the Asthma Research division, co-director of the Office of Pediatric Clinical Fellowship, and attending physician at the CCHMC and director of the medical scientist training program at the University of Cincinnati College of Medicine, says the assessment will be most valuable for use with young children who have experienced wheezing by ages 1 and 2 years.
“Parents often ask, ‘does this mean my child will have asthma?’ or ‘what is my child’s risk of asthma?’” she says. “Now we can answer that more accurately.”
Asthma affects 25.7 million Americans including 7 million children, and costs $5 billion globally each year in drug costs alone, according to the report. Prevention of the disease has long been difficult, partly because clinicians have largely been unable to predict an individual’s risk of developing asthma. The National Institutes of Health has identified zeroing in on better predicting asthma risk as a goal, and several attempts have been made to reach this goal. The Asthma Predictive Index (API), developed in 2004, has been generally accepted as the most valid tool developed so far, according to the report. Although this tool is useful in identifying children who will not have asthma, researchers who developed the PARS tool say the API “leaves much room for improvement in terms of identifying children who will have asthma.”
Assessment beyond the API
The research team that developed the PARS reported working to create a tool that would take into consideration more stringent, personal criteria than the API, including sensitization to allergens and food allergies.
To create the PARS tool, the research team used the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) birth cohort and developed a personalized, predictive algorithm that integrates both clinical and demographic factors. The tool was tested against the API, and findings were replicated using the Isle of Wight birth cohort in addition to the CCAAPS cohort, according to the report.
Of the 762 participants in the CCAAPS cohort, researchers note that 589 were objectively assessed for asthma by age 7 years and that prevalence was 16%. Some of the factors included in the predictive analysis of the tool include incidence of parental asthma, early wheezing by the child, wheezing outside a cold, eczema, age, gender, race, and skin-prick test results. According to the data, the children who had asthma at age 7 years were more likely to have a parent with asthma; eczema before age 3 years; a wheeze apart from the occurrence of a cold; early or frequent generalized wheezing; diagnosis of or probable presence of allergic rhinitis before age 3 years; have 2 or more positive skin-prick test responses to allergens or foods; or be African American.
When the PARS was compared with the API, the research team noted that the PARS tool was more effective at predicting asthma incidence in children with lower risk scores.
1. Biagini Myers JM, Schauberger E, He H, et al. A Pediatric Asthma Risk Score to better predict asthma development in young children. J Allergy Clin Immunol. December 7, 2018. Epub ahead of print. Available at: https://www.jacionline.org/article/S0091-6749(18)31577-X/fulltext. Accessed January 17, 2019.