Children with high risk to develop asthma by the Pediatric Asthma Risk Score have more acute symptoms at presentation than those who are low risk

The Pediatric Asthma Risk Score was recently validated to provide physicians with information regarding their patients’ future risk of developing asthma. We wanted to know if infants and toddlers with high risk (HR) for future asthma would present with more acute symptoms during wheezing events than those with low risk (LR). We were also interested in biomarkers that would predict similarly. We recruited 210 subjects ages 0-4 years from the Emergency Department. Baseline Pediatric Respiratory Symptoms (PRS) Scores were recorded. Pediatric Asthma Risk Score was obtained for each subject. Nasopharyngeal swabs were used to detect the presence of multiple viruses by viral genome sequencing. Nasal filter paper was used to collect nasal mucosal lining fluid, and after elution, inflammatory mediators were analyzed using bead-array immunoassay. Those subjects with HR for asthma had higher symptom scores by PRS than those with LR (HR, mean [SD], 7.11 [3.96]; LR, 3.83 [3.17]; p<0.0001). High risk patients with any viral infection at the time of presentation trended towards more symptoms than HR patients without viral infection (HR +virus, 9.182 [3.710]; HR -virus, 5 [1.826]; p=0.06). Acute symptom scores at the time of wheezing illnesses are worse in those at HR for future asthma. More work is required to determine if symptom scores actually predict future asthma in these subjects.