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Predicting asthma outcomes in wheezing infants
- Ramesh J Kurukulaaratchy, Martha Scott, and S Hasan Arshad (7 August 2008)
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Ramesh J Kurukulaaratchy, Consultant Physician in Allergy and Respiratory Medicine The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, IW, PO30 5TG, Martha Scott, and S Hasan Arshad
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Predicting the outcome of early life wheezing is a vexing problem for both parent and care-giver. We therefore welcome the attention brought to this matter by Frank et al’s recent paper 1. This seems to provide a simple solution to a complex question. However there are certain caveats to consider in interpreting this work. Findings that wheezy infants with a history of “atopic disorders” are at increased risk of asthma are hardly novel. Our own paper 2 5 years ago demonstrated the significant influence of atopic sensitisation in early life in predicting persistent outcome of early life wheezing. A simple risk score such as Frank et als’, not reliant on invasive testing is an attractive concept. The question though arises as to how reliable a questionnaire/history based definition of “atopic disorder” is. Of course atopy strictly speaking corresponds to the demonstration of specific sensitisation to culprit allergen. As we have demonstrated in the past, significant proportions of apparently childhood allergic diseases such as eczema 3 and rhinitis 4 may not be atopic at all. Furthermore, our prior work seems to suggest that it is atopic sensitisation and not “possibly allergic symptoms” that actually bear significant influence on persistent wheezing risk. For wide acceptability, the factors contributing to a “predictive score” should be unambiguous. Frank et al’s score relies on demonstrating “exercise induced wheeze”, in early life. In actual clinical practice that may not be as easy to define. The accompanying Editorial 5 quite rightly points to the difficulty in accurately labelling childhood wheeze. The authors fail to compare their “predictive tool” with our published risk scores to show that theirs is indeed an improvement, rather than a simplification, on what is already known. We proposed a simple and practical risk scoring system for outcome of early life wheeze 2 comprising 4 factors (family history of asthma, recurrent chest infections at 2-years, absence of nasal symptoms in infancy and atopic sensitisation at 4-years) showing independent significance for persistence of early wheeze to age 10 in our Cohort. Presence of all 4 was associated with a PPV of 83.3 and NPV of 63.9 for persistent disease. A simple tool to accurately predict outcome of early life wheeze is clearly desirable. Whilst welcoming this new addition to the literature we feel that its simplicity fails to provide a comprehensive answer to a decidedly complex question. The search for a predictive scoring system, which is practical, valid, and clinically useful, must continue! Yours sincerely Dr Ramesh J Kurukulaaratchy References:
Competing interests: None declared |
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