Can childhood asthma be predicted at birth?

Summary Background Early life appears optimal for prevention of asthma, but interventions require a relevant target population, to date not clearly identified at birth. Objective We therefore aimed to identify the predicting capacity of factors known around birth for asthma and rhinitis at 10 years. Methods The included 614 healthy term babies with lung function measured at birth in the 1992/1993 Environment and Childhood Asthma study in Oslo attended a 10-year follow-up visit including a structured interview and skin prick test (SPT) for allergies. The logistic regression analyses included 37 general variables from an extensive birth questionnaire; lung function; cord blood total immunoglobulin E and soluble CD14. A history of asthma, current asthma, history of rhinitis and ‘healthy’ (no history of asthma, rhinitis and negative SPT) was predicted on a group level and individual predicted probabilities were calculated. Results The predictability of the models [area under the curve (95% confidence intervals)] was 0.74 (0.69, 0.79), 0.72 (0.64, 0.78), 0.69 (0.54, 0.72) and 0.67 (0.62, 0.71) for a history of asthma, current asthma, rhinitis and ‘healthy’, respectively. The best model predicted a history of asthma correctly in 93/124 (75%), and incorrectly in 176/490 (36%) children without asthma. The positive predictive values for all outcomes were low (19–61), the highest predicting healthy. Conclusion Although at best 75% of children with a history of asthma could be predicted at birth, an intervention applied to our predicted high-risk children would be started more often in children without than with future disease. Parental allergic disease alone appears insufficient to identify high-risk populations in future studies of asthma and allergic disease. Cite this as: K. C. Lodrup Carlsen, P. Mowinckel, B. Granum and K.-H. Carlsen, Clinical & Experimental Allergy, 2010 (40) 1767–1775.