Klin Padiatr 2022; 234(01): 14-19
DOI: 10.1055/a-1500-8264
Original Article

Retrospective Cross-sectional Analysis of Factors Associated with Asthma in a Pediatric Cohort from Turkey

Retrospektive Querschnittsanalyse von mit Asthma assoziierten Faktoren in einer pädiatrischen Kohorte aus der Türkei
1   Department of Pediatric Immunology and Allergy, Ege University Faculty of Medicine, Izmir, Turkey
Cem Murat Bal
2   Department of Pediatric Pulmonology, Ege University Faculty of Medicine, Izmir, Turkey
Remziye Tanac
1   Department of Pediatric Immunology and Allergy, Ege University Faculty of Medicine, Izmir, Turkey
Figen Gulen
1   Department of Pediatric Immunology and Allergy, Ege University Faculty of Medicine, Izmir, Turkey
Esen Demir
1   Department of Pediatric Immunology and Allergy, Ege University Faculty of Medicine, Izmir, Turkey
› Author Affiliations


Background It is difficult to identify young children at increased risk of developing asthma amongst those with recurrent wheezing. In this study, we aimed to determine factors associated with asthma in Turkish children.

Methods We performed a retrospective cross-sectional analysis on factors associated with asthma in 651 children (200 girls, 451 boys) admitted for recurrent wheezing.

Results Amongst all included children, asthma frequency was 57.7%. Maturity, consanguinity, family income, passive smoking, father’s, siblings’ asthma were not found to be associated with asthma. Factors associated with asthma were: family’s, parents’, siblings’ atopy, family’s, mother’s asthma, allergic rhinitis and atopic dermatitis, respiratory symptoms between wheezing attacks. The sensitivity (SN) of the modified asthma predictive index (mAPI) was 59.2% with a specificity (SP) of 91.3%, positive predictive index (PPI) of 65.1% and negative predictive index (NPI) of 82.3%. The SN of the modified Prevention and Incidence of Asthma and Mite Allergy (PIAMA) score was 22.9% with a SP of 89.2%, PPI of 84.6%, and NPI of 42.2%. Adjusted odds ratio for mAPI was 12.9, and for the modified PIAMA score 4.

Conclusion Our analysis confirmed previously described factors associated with asthma. Although the SN is limited, the mAPI and PIAMA risk scores can be used to predict asthma in Turkish children. Differential diagnoses and overlaps with other chronic pediatric diseases such as immunodeficiencies need to be carefully excluded when confirming the diagnosis asthma.


Hintergrund Es ist schwierig, unter Kindern mit wiederkehrendem Giemen jene zu identifizieren, die ein Asthma entwickeln. In der vorliegenden Arbeit untersuchten wir die Faktoren, unter türkischen Kindern mit wiederholt giemender Atmung, die mit Asthma assoziiert sind.

Methode In einer retropsektiven Analyse untersuchten wir die Faktoren, die mit Asthma assoziiert sind unter 651 Kindern (200 Mädchen, 451 Jungen), mit wiederkehrendem Giemen.

Ergebnisse Die Asthmahäufigkeit unter allen analysierten Patienten betrug 57,7%. Frühgeburtlichkeit, Konsanguinität der Eltern, Familieneinkommen, Passivrauchen, Asthma von Vater, Geschwistern zeigten sich nicht als mit Asthma assoziiert. Mit Asthma assoziiert waren: Atopie in der Familie unter Eltern und Geschwistern, positive Familienanamnese für Asthma; allergische Rhinitis und atopische Dermatitis; Atemwegsbeschwerden zwischen den Giemen Perioden. Die Sensitivität (SN) des modifizierten asthma predictive index (mAPI) für Asthma betrug 59,2%, die Spezifität (SP) betrug 91,3%, der positive Vorhersageindex (PPI) betrug 65,1% und der negative Vorhersageindex (NPI) 82,3%. Die Sensitivität der modifizierten Prevention and Incidence of Asthma and Mite Allergy (PIAMA) Risikobewertung betrug 22,9% bei einer SP von 89,2%, PPI von 84,6% und NPI von 42,2%. Die angepasste Odds-Ratio für mAPI lag bei 12,9 und für die modifizierte PIAMA-Risikobewertung bei 4.

Schlussfolgerung Die mit Asthma assoziierte bisherigen Faktoren wurden in unserer Studie bestätigt. Obwohl unsere Studie eine niedrige SN zeigten, können die mAPI und die modifizierte PIAMA-Ergebnisse hilfreich sein, Asthma unter türkischen Kindern vorherzusagen. Wichtig dabei ist es bei der Beurteilung des Asthmarisikos unter Kindern mit wiederkehrendem Giemen, das relevante Differentialdiagnosen wie z. B. İmmundefekte, augeschlossen werden.

Publication History

Article published online:
30 July 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Amin P, Levin L, Epstein T. et al. Optimum predictors of childhood asthma: persistent wheeze or the Asthma Predictive Index?. J Allergy Clin Immunol Pract 2014; 2: 709-715
  • 2 Arif AA, Veri SD. The association of prenatal risk factors with childhood asthma. J Asthma 2018; 1: 1-6
  • 3 Bao Y, Chen Z, Liu E. et al. Risk Factors in Preschool Children for Predicting Asthma During the Preschool Age and the EarlySchool Age: a Systematic Review and Meta-Analysis. Curr Allergy Asthma Rep 2017; 17: 85
  • 4 Brunekreef B, Smit J, de Jongste J. et al. The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study: design and first results. Pediatr Allergy Immunol 2002; 13: 55-60
  • 5 Castro-Rodriguez JA. The Asthma Predictive Index: a very useful tool for predicting asthma in young children [review]. J Allergy Clin Immunol 2010; 126: 212-216
  • 6 Castro-Rodriguez JA. The Asthma Predictive Index: early diagnosis of asthma [review]. Curr Opin Allergy Clin Immunol 2011; 11: 157-161
  • 7 Castro-Rodriguez JA, Holberg CJ, Wright AL. et al. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med 2000; 162: 1403-1406
  • 8 Chang TS, Lemanske RF, Guilbert TW. et al. Evaluation of the modified Asthma Predictive Index in high-risk preschool children. J Allergy Clin Immunol Pract 2013; 1: 152-156
  • 9 Crapo RO, Casaburi R, Coates AL. et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 2000; 161: 309-329
  • 10 Global Initiative for Asthma Global strategy for Asthma management and prevention: Revised. 2020. Bethesda: GINA;
  • 11 Golding J, Pembrey M, Jones R. ALSPAC–the Avon Longitudinal Study of Parents and Children, I: study methodology. Paediatr Perinat Epidemiol 2001; 15: 74-87
  • 12 Guilbert TW, Morgan WJ, Krawiec M. et al. The Prevention of Early Asthma in Kids study: design, rationale and methods for the Childhood Asthma Research and Education network. Control Clin Trials 2004; 25: 286-310
  • 13 Hafkamp-de Groen E, Lingsma HF, Caudri D. et al. Predicting asthma in preschool children with asthma-like symptoms: Validating and updating the PIAMA risk score. J Allergy Clin Immunol 2013; 132: 1303-1310
  • 14 Henderson J, Granell R, Heron J. et al. Associations of wheezing phenotypes in the first 6 years of life with atopy, lung function and airway responsiveness in mid-childhood. Thorax 2008; 63: 974-980
  • 15 Leonardi NA, Spycher BD, Strippli MP. et al. Validation of the Asthma Predictive Index and comparison with simpler clinical prediction rules. J Allergy Clin Immunol 2011; 127: 1466-1472
  • 16 Loftus PA, Wise SK. Epidemiology of asthma. Curr Opin Otolaryngol Head Neck Surg 2016; 24: 245-249
  • 17 Looijmans-van den Akker I, van Luijn K, Verheij T. Overdiagnosis of asthma in children in primary care: a retrospective analysis. Br J Gen Pract 2016; 66: e152-e157
  • 18 Martinez FD, Wright AL, Taussig LM. et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995; 332: 133-138
  • 19 Martinez FD. What have we learned from the Tucson Children’s Respiratory Study?. Paediatr Respir Rev 2002; 3: 193-197
  • 20 Pembrey M. The Avon Longitudinal Study of Parents and Children (ALSPAC): a resource for genetic epidemiology. Eur J Endocrinol 2004; 151: U125-U129
  • 21 Rodriguez-Martinez CE, Sossa-Briceno MP, Castro-Rodriguez JA. Discriminative properties of two predictive indices for asthma diagnosis in a sample of preschoolers with recurrent wheezing. Pediatr Pulmonol 2011; 46: 1175-1181
  • 22 Savenije OE, Granell R, Caudri D. et al. Comparison of childhood wheezing phenotypes in 2 birth cohorts: ALSPAC and PIAMA. J Allergy Clin Immunol 2011; 127: 1505-1512
  • 23 Savenije OE, Kerkhof M, Koppelman GH. et al. Predicting who will have asthma at school age among preschool children. J Allergy Clin Immunol 2012; 130: 325-331
  • 24 Stein RT, Martinez FD. Asthma phenotypes in childhood: lessons from an epidemiological approach. Paediatr Respir Rev 2004; 5: 155-161
  • 25 Teijeiro A, Badellino H, Raiden MG. et al. Risk factors for recurrent wheezing in the first year of life in the city of Córdoba, Argentina. Allergol Immunopathol (Madr) 2017; 45: 234-239