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. 2014 Nov-Dec;2(6):709-15.
doi: 10.1016/j.jaip.2014.08.009. Epub 2014 Nov 6.

Optimum predictors of childhood asthma: persistent wheeze or the Asthma Predictive Index?

Priyal Amin  1 , Linda Levin  2 , Tolly Epstein  3 , Pat Ryan  4 , Grace LeMasters  2 , Gurjit Khurana Hershey  5 , Tina Reponen  2 , Manuel Villareal  1 , James Lockey  6 , David I Bernstein  7
Affiliations

Optimum predictors of childhood asthma: persistent wheeze or the Asthma Predictive Index?

Priyal Amin et al. J Allergy Clin Immunol Pract. 2014 Nov-Dec.

Abstract

Background: The Asthma Predictive Index (API) and persistent wheezing phenotypes are associated with childhood asthma, but previous studies have not assessed their ability to predict objectively confirmed asthma.

Objective: To determine whether the University of Cincinnati API Index (ucAPI) and/or persistent wheezing at age 3 can accurately predict objectively confirmed asthma at age 7.

Methods: Data from the Cincinnati Childhood Allergy and Air Pollution Study, a high-risk prospective birth cohort, was used. Asthma was defined as parent-reported or physician-diagnosed asthma objectively confirmed by a change in FEV1 of ≥12% after bronchodilator or a positive methacholine challenge (PC20 ≤ 4 mg/mL); or as prior treatment with daily asthma controller medication(s). Multivariate logistic regression was used to investigate the relationship between confirmed asthma at age 7 and a positive ucAPI (adapted and modified from prior published API definitions) and persistent wheezing at age 3.

Results: At age 7, 103 of 589 children (17.5%) satisfied the criteria for asthma. Confirmed asthma at age 7 was significantly associated with a positive ucAPI (adjusted odds ratio [aOR] 13.3 [95% CI, 7.0-25.2]; P < .01) and the persistent wheezing phenotype (aOR 9.8 [95% CI, 4.9-19.5]; P < .01) at age 3. Allergic persistent wheezing was associated with a significantly higher risk of asthma (aOR 10.4 [95% CI, 4.1-26.0]; P < .01) than nonallergic persistent wheezing (aOR 5.4 [95% CI, 2.04-14.06]; P < .01).

Conclusion: Both a positive ucAPI and persistent wheeze at age 3 were associated with objectively confirmed asthma at age 7; however, the highest risk was associated with ucAPI. These results demonstrate the ucAPI as a clinically useful tool for predicting future asthma in school-age children.

Keywords: Asthma; Asthma Predictive Index; Asthma prediction; Atopic persistent wheezing; Childhood asthma; Nonatopic persistent wheezing; Persistent wheezing; Wheezing phenotypes.

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