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Open Access Highly Accessed Study protocol

Predicting asthma in preschool children with asthma symptoms: study rationale and design

Esther Hafkamp-de Groen12*, Hester F Lingsma2, Daan Caudri3, Alet Wijga4, Vincent WV Jaddoe156, Ewout W Steyerberg2, Johan C de Jongste3 and Hein Raat2

Author Affiliations

1 The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands

2 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands

3 Department of Paediatrics, Division of Respiratory Medicine, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands

4 Centre for Prevention and Health Services Research / National Institute for Public Health and the Environment, Bilthoven, The Netherlands

5 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands

6 Department of Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands

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BMC Pulmonary Medicine 2012, 12:65  doi:10.1186/1471-2466-12-65

Published: 16 October 2012

Abstract

Background

In well-child care it is difficult to determine whether preschool children with asthma symptoms actually have or will develop asthma at school age. The PIAMA (Prevention and Incidence of Asthma and Mite Allergy) Risk Score has been proposed as an instrument that predicts asthma at school age, using eight easy obtainable parameters, assessed at the time of first asthma symptoms at preschool age. The aim of this study is to present the rationale and design of a study 1) to externally validate and update the PIAMA Risk Score, 2) to develop an Asthma Risk Appraisal Tool to predict asthma at school age in (specific subgroups of) preschool children with asthma symptoms and 3) to test implementation of the Asthma Risk Appraisal Tool in well-child care.

Methods and design

The study will be performed within the framework of Generation R, a prospective multi-ethnic cohort study. In total, consent for postnatal follow-up was obtained from 7893 children, born between 2002 and 2006. At preschool age the PIAMA Risk Score will be assessed and used to predict asthma at school age. Discrimination (C-index) and calibration will be assessed for the external validation. We will study whether the predictive ability of the PIAMA Risk Score can be improved by removing or adding predictors (e.g. preterm birth). The (updated) PIAMA Risk Score will be converted to the Asthma Risk Appraisal Tool- to predict asthma at school age in preschool children with asthma symptoms. Additionally, we will conduct a pilot study to test implementation of the Asthma Risk Appraisal Tool in well-child care.

Discussion

Application of the Asthma Risk Appraisal Tool in well-child care will help to distinguish preschool children at high- and low-risk of developing asthma at school age when asthma symptoms appear.

This study will increase knowledge about the validity of the PIAMA risk score and might improve risk assessment of developing asthma at school age in (specific subgroups of) preschool children, who present with asthma symptoms at well-child care.

Keywords:
Asthma Risk Appraisal Tool; Children; External validation; Prediction; Well-child care