Symptom-Based Screening Tool Successfully Identifies Young Children with High Asthma Risk

According to the U.S. Centers for Disease Control and Prevention (CDC), healthcare costs for asthma amount to about $50 billion per year. Over 26 million Americans have asthma, including 6.5% of children under 18 years of age.

Given that persistent wheezing, a hallmark asthma symptom, is associated with decreased lung function and chronic lung disease, identifying children with potential asthma risk at a young age can allow for early treatment, preserve lung function, and decrease hospital and emergency room visits that drive healthcare costs.

Currently, screening tools exist for predicting asthma risk in school-aged children. However, most are invasive, requiring skin pricks or blood draws, making them difficult to use with young, preschool-aged children.

In a study published last October in the Journal of the American Medical Association (JAMA), Myrtha E. Reyna, M.Sc., from the Department of Pediatrics at The Hospital for Sick Children (SickKids) in Toronto, Canada, and colleagues used data from the CHILD cohort Study to develop a screening tool that could be easily used in primary care settings to identify children as young as 3 years of age at risk for asthma. The CHILD Cohort Study is a prospective, longitudinal study that follows participants from mid-pregnancy through adolescence across four Canadian sites.

Reyna and colleagues used information obtained from parents’ answers in child health questionnaires to develop the CHILDhood Asthma Risk Tool (CHART). The CHART categorized children as having low, moderate, or high asthma risk based on factors reported before 3 years of age. These included wheezing, coughing, use of inhaled corticosteroids or bronchodilators, use of oral corticosteroids, and asthma- or wheeze-related emergency room visits and hospitalizations.

CHART successfully identified children with high asthma risk as young as 3 years of age. The screening tool was found to be more accurate at predicting asthma, persistent wheezing, and related emergency room visits and hospitalizations than standard screening and diagnostic tools.

CHART recommends follow-up actions for all children identified with asthma risk, regardless of the level of risk. Reyna and colleagues propose using this tool as an early screening device that may aid in providing early asthma control to improve patients’ quality of life and reduce healthcare costs.

They write, “Although early identification of asthma in children may not change the natural history of the disease, a current goal of asthma treatment is to minimize symptom burden and risk of asthma attacks. The implementation of CHART as a first-step screening tool in general practice could promote timely treatment control and, in turn, improve quality of life for patients and reduce the clinical and economic burden of asthma.”