Prediction of asthma in young adults using childhood characteristics: Development of a prediction rule.

OBJECTIVE To develop an easily applicable prediction rule for asthma in young adulthood using childhood characteristics. METHODS A total of 1,055 out of 1,328 members of a Dutch birth cohort were followed from 2 to 21 years of age. Univariate and multivariate logistic regression analyses were used to evaluate the predictive value of childhood characteristics on asthma at 21 years of age. A prognostic function was developed, and the area under the receiving operating characteristic (ROC) curve was used to estimate the predictive ability of the prognostic models. RESULTS Of the 693 responding subjects, 86 (12%) were diagnosed with asthma. Independent prognostic factors at ages 2 and 4 years were female gender (odds ratios (OR) 1.9 and 2.1; 95% confidence intervals (CI) 1.2-3.2 and 1.3-2.5), smoking mother (OR 1.6 and 1.6; CI 1.0-2.7 and 1.0-2.6), lower respiratory tract illness (OR 1.9 and 2.4; CI 1.0-3.6 and 1.4-4.0), and atopic parents (OR 2.1 and 1.9; CI 1.3-3.4 and 1.2-3.1). The predictive power of both models was poor; area under ROC curve was 0.66 and 0.68, respectively. CONCLUSION Asthma in young adulthood could not be predicted satisfactorily based on childhood characteristics. Nevertheless, we propose that this method is further tested as a tool to predict development of asthma.

[1]  D. Strachan,et al.  Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort , 1996, BMJ.

[2]  Airway remodelling takes place in asthma — what are the clinical implications? , 1997, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[3]  D. Hosmer,et al.  Applied Logistic Regression , 1991 .

[4]  S T Holgate,et al.  Predicting persistent disease among children who wheeze during early life , 2003, European Respiratory Journal.

[5]  G. Grunkemeier,et al.  Receiver operating characteristic curve analysis of clinical risk models. , 2001, The Annals of thoracic surgery.

[6]  E. Ford Current reviews of allergy and clinical immunology , 2005 .

[7]  J. Castro‐Rodriguez,et al.  A clinical index to define risk of asthma in young children with recurrent wheezing. , 2000, American journal of respiratory and critical care medicine.

[8]  G A Diamond,et al.  What price perfection? Calibration and discrimination of clinical prediction models. , 1992, Journal of clinical epidemiology.

[9]  B. Niggemann,et al.  The pattern of atopic sensitization is associated with the development of asthma in childhood. , 2001, The Journal of allergy and clinical immunology.

[10]  P. van den Broek,et al.  The otological profile of a cohort of Dutch 7.5-8-year-olds. , 1993, Clinical otolaryngology and allied sciences.

[11]  B. Toelle,et al.  Childhood factors that predict asthma in young adulthood , 2004, European Respiratory Journal.

[12]  H. Sox,et al.  Clinical prediction rules. Applications and methodological standards. , 1985, The New England journal of medicine.

[13]  J B Carlin,et al.  Factors in childhood as predictors of asthma in adult life , 1994, BMJ.

[14]  Gerben ter Riet,et al.  Accuracy of specific IgE in the prediction of asthma: development of a scoring formula for general practice. , 2005, The British journal of general practice : the journal of the Royal College of General Practitioners.

[15]  A Rogier T Donders,et al.  Penalized maximum likelihood estimation to directly adjust diagnostic and prognostic prediction models for overoptimism: a clinical example. , 2004, Journal of clinical epidemiology.

[16]  M. Hibbert,et al.  Outcome of childhood asthma in mid-adult life , 1994, BMJ.

[17]  A. Laupacis,et al.  Clinical prediction rules. A review and suggested modifications of methodological standards. , 1997, JAMA.

[18]  A. Gulsvik,et al.  Nonresponse in a community cohort study: predictors and consequences for exposure-disease associations. , 2002, Journal of clinical epidemiology.

[19]  D G Altman,et al.  What do we mean by validating a prognostic model? , 2000, Statistics in medicine.

[20]  Phil A. Silva,et al.  A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. , 2003, The New England journal of medicine.

[21]  D. Strachan,et al.  International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. , 1995, The European respiratory journal.