The Preschool Asthma Risk Factors Scale: A predictive tool for asthma and respiratory symptoms among preschool children in Lebanon

Main Article Content

Hallit Souheil
Rahme Clara
Sacre Hala
Waked Mirna
Salameh Pascale

Keywords

asthma, risk factors, cohort, preschool children, gender, heating system, Lebanon

Abstract

Background: The Preschool Asthma Risk Factor Scale (PS-ARFS) is a tool that enables clinicians to assess environmental exposure of preschool children, history of parental asthma, and dietary habits. The objective of this study was to evaluate the PS-ARFS ability to predict asthma diagnosis and respiratory symptoms 1 year after baseline assessment and improve the scale if necessary.


Methods: A prospective cohort study conducted between November 2018 and March 2019 in three Lebanese schools (from three different Lebanese Governorates) enrolled 515 preschool children aged 3–5 years. Parents completed a detailed questionnaire sent with their children (Phase 1; T0). All parents who participated in Phase 1 were invited to take the same survey by telephone (Phase 2; T1), 1 year later. The interview was conducted by one study-independent person. Of the total sample, 141 (27.4%) children were lost to follow-up.


Results: Higher odds of asthma diagnosis at 1 year were significantly associated with playing outside (adjusted odds ratio [aOR] = 3.958) and having a heating system in the bedroom (aOR = 6.986) at baseline, but inversely associated with the female gender (aOR = 0.365). Based on those results, the improved PS-ARFS-I was generated. A higher PS-ARFS-I at T0 was significantly associated with higher odds of asthma at T1 (aOR = 1.08; p < 0.001; 95% confidence interval [CI] 1.05–1.10); similar results were obtained with the longer PS-ARFS (aOR = 1.079; p < 0.001; 95% CI 1.050–1.109). Moreover, among non-asthmatic children at baseline, the PS-ARFS score predicted wheezing and cough at T1 but not bronchial secretions; the PS-ARFS-I score at baseline did not predict symptoms at T1.


Conclusion: This study shows that the PS-ARFS-I and PS-ARFS could predict diagnosed asthma at 1-year follow-up. The PS-ARFS predicted respiratory symptoms (wheezing and cough) after 1 year among non-asthmatic children at baseline, suggesting that a score based on risk factors, measured early on, can predict better later symptoms and disease.

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