An easy-to-use novel symptom-based screening method has been developed by a group of researchers associated with the CHILD Cohort Study (CHILD) to identify the risk of asthma in children as young as two years old.
Research detailing the effectiveness of the instrument, known as the CHILDhood Asthma Risk Tool, or CHART, was published in the highly regarded Journal of the American Medical Association (JAMA).
Co-senior author Dr. Padmaja Subbarao, a respirologist and CRC Tier 1 Chair in Pediatric Asthma and Lung Health at The Hospital for Sick Children (SickKids) and the Director of CHILD, notes that asthma affects nearly 330 million people worldwide, has a significant financial impact on healthcare, and is the primary reason for hospitalisation for children in Canada, particularly those under five.
She is also an Adjunct Professor of Respirology and Medicine at McMaster University, as well as a Professor in the Department of Pediatrics at the University of Toronto.
“Earlier diagnosis of this ailment would help physicians to treat children more quickly, reducing their suffering and need for hospitalisation while also cutting costs to the healthcare system.”
According to the study’s co-first author, Myrtha E. Reyna-Vargas, an M.Sc. and a biostatistician at SickKids, “traditional asthma tests are difficult to do in children, time-consuming and intrusive, including skin pricks and blood-taking, therefore many patients and clinicians opt to avoid them.”
“Other traditional procedures can also need professional consultations and the use of expensive specialised equipment to measure lung function.”
Based on data reported before to the age of three, CHART assigns children a “High,” “Moderate,” or “Low” risk of developing asthma in the future and having chronic symptoms. Each group’s recommended next steps are provided by the tool.
“The wonderful thing about CHART, the new tool we have created, is that family physicians or nurses may utilise it in a primary care environment with limited resources. It is non-invasive, can be carried out immediately, is free of charge, and doesn’t call for specialised equipment. After demonstrating CHART’s advantages in the CHILD trial, we are presently striving to validate its prospective application in clinical practise.”
In the study, CHART was used to analyse data from 2,354 kids who took part in CHILD, a long-term study that began tracking roughly 3,500 Canadian kids’ physical, social, and cognitive development from before birth.
CHART was able to predict with 91% accuracy which of these children will have persistent wheeze—a major sign of asthma—by age five using information regarding the children’s wheezing and coughing episodes, usage of asthma drugs, and associated hospital visits at three years of age.
50% of the children identified by in-study doctors as having asthma by the age of five out of those identified by CHART as having a high risk of developing it at the age of three.
CHILD’s founding director and co-senior author of the study, Dr. Malcolm Sears, says, “We feel the instrument is really significantly more accurate at predicting asthma than this figure shows.
“It is possible that some of these young children have asthma that is yet not formally diagnosed due to several difficulties in how asthma is clinically characterised. The value of the tool’s predictive ability is undeniable because persistent wheeze symptoms, regardless of an official asthma diagnosis, have been linked to reduced lung function, chronic lung disease, and the same level of medical care utilisation as asthma. Persistent wheeze also necessitates similar monitoring and treatment.”
Overall, CHART was found to be more reliable than other common diagnostic techniques, such as doctor evaluations and the traditional asthma test known as the modified Asthma Predictive Index, in foretelling chronic wheeze, asthma, and related health care utilisation (mAPI).
By comparing CHART’s performance with information from two more cohort studies—the Canadian CAPPS Cohort, whose members are all at high risk for developing asthma, and the Australian general population Raine Study—the study’s results utilising CHILD data were also confirmed. In addition to performing well within these cohorts, CHART was also demonstrated to be successful when used with data from children as young as two years old, owing to data made accessible through the CAPPS Cohort.
Overall, CHART was found to be more reliable than other common diagnostic techniques, such as doctor evaluations and the traditional asthma test known as the modified Asthma Predictive Index, in foretelling chronic wheeze, asthma, and related health care utilisation (mAPI).
By comparing CHART’s performance with information from two more cohort studies—the Canadian CAPPS Cohort, whose members are all at high risk for developing asthma, and the Australian general population Raine Study—the study’s results utilising CHILD data were also confirmed. In addition to performing well within these cohorts, CHART was also demonstrated to be successful when used with data from children as young as two years old, owing to data made accessible through the CAPPS Cohort.
