Main Article Content
asthma; risk factors; cohort; preschool children; gender; heating system; Lebanon
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.
2. Ferrante G, La Grutta S. The burden of pediatric asthma. Front Pediatr. 2018;6:186. https://doi.org/10.3389/fped.2018.00186
3. Waked M, Salameh P. Risk factors for asthma and allergic diseases in school children across Lebanon. J Asthma Allergy.2008;2:1–7. https://doi.org/10.2147/JAA.S3844
4. Dharmage SC, Perret JL, Custovic A. Epidemiology of asthma in children and adults. Front Pediatr. 2019;7:246. https://doi.org/10.3389/fped.2019.00246
5. Musharrafieh U, Al-Sahab B, Zaitoun F, El-Hajj MA, Ramadan F, Tamim H. Prevalence of asthma, allergic rhinitis and eczema among Lebanese adolescents. J Asthma. 2009;46(4):382–387. https://doi.org/10.1080/02770900902777775
6. Ferrante G, La Grutta S. The burden of pediatric asthma. Front Pediatr. 2018;6:186–186. https://doi.org/10.3389/fped.2018.00186
7. Castro-Rodriguez JA, Forno E, Rodriguez-Martinez CE, Celedón JC. Risk and protective factors for childhood asthma: What is the evidence? J Allergy Clin Immunol Prac. 2016;4(6):1111–1122. https://doi.org/10.1016/j.jaip.2016.05.003
8. Beasley R, Semprini A, Mitchell EA. Risk factors for asthma: Is prevention possible? Lancet. 2015;386(9998):1075–1085. https://doi.org/10.1016/S0140-6736(15)00156-7
9. Ramagopal M, Wang Z, Black K, Hernandez M, Stambler AA, Emoekpere OH, et al. Improved exposure characterization with robotic (PIPER) sampling and association with children’s respiratory symptoms, asthma and eczema. J Expo Sci Environ Epidemiol. 2014;24(4):421–427. https://doi.org/10.1038/jes.2014.27
10. Neuman Å, Hohmann C, Orsini N, Pershagen G, Eller E, Kjaer HF, et al. Maternal smoking in pregnancy and asthma in preschool children: A pooled analysis of eight birth cohorts. Am J Respir Crit Care Med. 2012;186(10):1037–1043. https://doi.org/10.1164/rccm.201203-0501OC
11. Kanoh M, Kaneita Y, Hara M, Harada S, Gon Y, Kanamaru H, et al. Longitudinal study of parental smoking habits and development of asthma in early childhood. Prev Med. 2012;54(1):94–96. https://doi.org/10.1016/j.ypmed.2011.10.011
12. Waked M, Salameh P. Maternal waterpipe smoke exposure and the risk of asthma and allergic diseases in childhood: A post hoc analysis. Int J Occup Med Environ Health. 2015;28(1):147–156. https://doi.org/10.13075/ijomeh.1896.00316
13. Lee YJ, Fujisawa T, Kim C-K. Biomarkers for recurrent wheezing and asthma in preschool children. Allergy Asthma Immunol Res. 2019;11(1):16–28. https://doi.org/10.4168/aair.2019.11.1.16
14. Jat KR. Spirometry in children. Prim Care Respir J. 2013;22(2):221–229. https://doi.org/10.4104/pcrj.2013.00042
15. Hallit S, Raherison C, Malaeb D, Hallit R, Waked M, Kheir N, et al. Development of an asthma risk factors scale (ARFS) for
risk assessment asthma screening in children. Pediatr Neonatol. 2019;60(2):156–165. https://doi.org/10.1016/j.pedneo.2018.05.009
16. Hallit S, Sacre H, Kheir N, Hallit R, Waked M, Salameh P. Prevalence of asthma, its correlates, and validation of the Pre-School Asthma Risk Factors Scale (PS-ARFS) among preschool children in Lebanon. Allergol Immunopathol (Madr).
17. Four, B., Hajjar, Y., Bibi, G., Chahab, M., & Zaazaa, R. (2006). Comparative regional analysis of ECCE in four Arab countries (Lebanon, Jordan, Syria, and Sudan). Arab Resource Collective, 2007–2007 (Paper commissioned for the EFA Global Monitoring Report).
18. Hallit S, Salameh P. Exposure to toxics during pregnancy and childhood and asthma in children: A pilot study. J Epidemiol Glob Health. 2017;7(3):147–154. https://doi.org/10.1016/j.jegh.2017.04.004
19. Asher M, Keil U, Anderson H, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC): Rationale and methods. Eur Respir J. 1995;8(3):483–491. https://doi.org/10.1183/09031936.95.08030483
20. Hallit S, Raherison C, Abou Abdallah R, Hallit R, Salameh P. Correlation of types of food and asthma diagnosis in childhood: A case-control study. J Asthma. 2018;55(9):966–974. https://doi.org/10.1080/02770903.2017.1379535
21. Hallit S, Raherison C, Waked M, Salameh P. Association between caregiver exposure to toxics during pregnancy and childhood-onset asthma: A case-control study. Iran J Allergy Asthma Immunol. 2017;16(6):488–500.
22. Malaeb D, Hallit S, Sacre H, Hallit R, Salameh P. Factors associated with wheezing among Lebanese children: Results of a cross-sectional study. Allergol Immunopathol (Madr). 2020;48(6):523–529. https://doi.org/10.1016/j.aller.2020.02.003
23. Melki IS, Beydoun HA, Khogali M, Tamim H, Yunis KA, National Collaborative Perinatal Neonatal N. Household crowding index: A correlate of socioeconomic status and inter-pregnancy spacing in an urban setting. J Epidemiol Community Health. 2004;58(6):476–480. https://doi.org/10.1136/jech.2003.012690
24. Van der Mark LB, Van Wonderen KE, Mohrs J, Van Aalderen WM, Ter Riet G, Bindels PJ. Predicting asthma in preschool children at high risk presenting in primary care: Development of a clinical asthma prediction score. Prim Care Respir J. 2014;23(1):52–59. https://doi.org/10.4104/pcrj.2014.00003
25. Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014;383(9928):1581–1592. https://doi.org/10.1016/S0140-6736(14)60617-6
26. Golden R, Holm S. Indoor air quality and asthma: Has unrecognized exposure to acrolein confounded results of previous studies? Dose Response. 2017;15(1):1559325817691159. https://doi.org/10.1177/1559325817691159
27. Breysse PN, Diette GB, Matsui EC, Butz AM, Hansel NN, McCormack MC. Indoor air pollution and asthma in children. Proc Am Thorac Soc. 2010;7(2):102–106. https://doi.org/10.1513/pats.200908-083RM