{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:41:16Z","timestamp":1792410076513,"version":"4.4.0"},"reference-count":40,"publisher":"European Respiratory Society (ERS)","issue":"5","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["Advanced Fellowship NIHR302205"],"award-info":[{"award-number":["Advanced Fellowship NIHR302205"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2026,5,25]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Almost half of all children experience wheeze before their sixth birthday, with a subset experiencing recurrent attacks that increase healthcare burden. Early identification of children at high risk could enable timely interventions, but diagnostic tools are limited. The aim of the present study was to develop and validate a prognostic model predicting the risk of recurrent wheeze attacks (primary outcome) and hospitalisations (secondary outcome) within 12\u2005months of an initial preschool acute wheeze presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We developed a multivariable logistic regression model using primary care data from 42\u2009820 children in England aged up to 5\u2005years with acute wheeze episodes recorded in the Clinical Practice Research Datalink. Predictors included demographics, clinical history and treatment patterns. The model was validated internally\n                      <jats:italic>via<\/jats:italic>\n                      bootstrapping and externally using the Secure Anonymised Information Linkage Databank in Wales (9703 children). Model performance was assessed using calibration and discrimination metrics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the CPRD development cohort, 39.6% experienced a subsequent wheeze attack and 17.4% were hospitalised. Key predictors were the healthcare setting of initial acute wheeze, prior wheeze history and reliever prescriptions; inhaled corticosteroid prescriptions reduced risk. The model demonstrated excellent calibration across internal bootstrap validation and two external validation cohorts (calibration slope=1.00, 0.94 and 0.86, respectively, calibration-in-the-large=0.00, 0.035 and \u22120.143) and moderate discrimination (C-statistic=0.634, 0.625 and 0.638 for wheeze).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using routinely collected data, the prognostic model shows strong calibration and moderate discrimination for predicting recurrent wheeze in preschool children. Implementation as a web tool could support early risk stratification and guide preventative management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/23120541.00337-2026","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T15:50:19Z","timestamp":1781797819000},"page":"00337-2026","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and external validation of a risk prediction tool for recurrent wheeze attacks in preschool children in England"],"prefix":"10.1183","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1846-2150","authenticated-orcid":false,"given":"Jonathan","family":"Broomfield","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erol A.","family":"Gaillard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-4869","authenticated-orcid":false,"given":"Jennifer K.","family":"Quint","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5976-8386","authenticated-orcid":false,"given":"Hilary","family":"Pinnock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare L.","family":"Gillies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad A.","family":"Al Sallakh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwyneth A.","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David K.H.","family":"Lo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"2026101903500846000_12.5.00337-2026.1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2007.093187"},{"key":"2026101903500846000_12.5.00337-2026.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199501193320301"},{"key":"2026101903500846000_12.5.00337-2026.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)04958-8"},{"key":"2026101903500846000_12.5.00337-2026.4","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00015712"},{"key":"2026101903500846000_12.5.00337-2026.5","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.20486"},{"key":"2026101903500846000_12.5.00337-2026.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.12.643"},{"key":"2026101903500846000_12.5.00337-2026.7","doi-asserted-by":"crossref","first-page":"e519","DOI":"10.1542\/peds.2008-2867","article-title":"Efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing and asthma: a systematic review with meta-analysis","volume":"123","author":"Castro-Rodriguez","year":"2009","journal-title":"Pediatrics (Evanston)"},{"key":"2026101903500846000_12.5.00337-2026.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2016.09.028"},{"key":"2026101903500846000_12.5.00337-2026.9","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1038\/s41533-019-0140-z","article-title":"Qualitative study of practices and challenges when making a diagnosis of asthma in primary care","volume":"29","author":"Akindele","year":"2019","journal-title":"NPJ Prim Care Respir Med"},{"key":"2026101903500846000_12.5.00337-2026.10","unstructured":"Global Initiative for Asthma . 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