Predicting asthma in preschool children with asthma symptoms: study rationale 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.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.Asthma symptoms in preschool children are non-specific. It is therefore difficult to determine which preschool children with asthma symptoms actually have or will develop asthma at school age [1]. A recent study has shown that both undertreatment and overtreatment of asthma in children between ages 2 and 8 years seem common [2]. Inadequate risk assessment of asthma when children present with asthma symptoms at well-child care may be an important cause of inadequate treatment of childhood asthma. To improve early diagnosis and management of asthma symptoms, we reasoned that early detection of preschool children at high risk of developing asthma at school age is important.In this study we present the rationale and design of a study focusi