Adult asthma risk predicted from childhood symptoms

A new scoring system can predict how likely young children with symptoms such as wheezing are to have asthma in later life.

Asthma symptoms, such as wheezing, are common in early childhood. Yet predicting which children will go on to have asthma as an adult is difficult.

Prof Hasan Arshad is a Professor and Consultant in Allergy and Clinical Immunology in Southampton. He has led the development of the new scoring system, with results published in the journal Allergy.

He is part of the NIHR Southampton Biomedical Research Centre (BRC). Our BRC’s Prof Graham Roberts and Dr Ramesh Kurukulaaratchy were also involved in the research.

Based on children’s symptoms

The new scoring system is known by the acronym ASPIRE. Symptoms that can be identified by a doctor - such as wheeze, allergies, eczema and chest infections - are used to generate a score.

Each symptom is given a different weighting to indicate its importance. A higher overall score indicates an increased risk of the child having asthma at ages 10, 18 and 26 years.

They developed ASPIRE using data from the Isle of Wight Birth Cohort. This is a group of 1,456 people living on the island and had visits at ages one, two, four, 10, 18 and 26 years. These visits included a detailed assessment of any allergies or asthma they had.

Testing the scoring system

The researchers created four versions of ASPIRE, using different symptoms and weightings.

Two were then tested using data from participants in The Manchester Asthma and Allergy Study (MAAS) and The Avon Longitudinal Study of Parents and Children (ALSPAC).

They showed that ASPIRE is better than the current front-runner, known as PARS. The most effective version was ASPIRE-1, which only uses recurrent wheeze and a positive skin prick test for allergies.

As their previous research showed four allergies - house dust mites, cats, grass pollen and a type of mould - are most relevant to asthma, they suggest testing for these.

Prof Arshad said: “We hope that ASPIRE will be used by primary care physicians, paediatricians and allergists across the world to improve the management of wheezy children, by providing a reliable risk assessment of later asthma development.”

“In collaboration with Dr Zhang, Professor and Head of Biostatistics at the University of Memphis, we are now in the process of developing a webtool and mobile app to assist doctors in the use of ASPIRE in clinics.”