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Predicting persistence of asthma in preschool wheezers: crystal balls or muddy waters?
Sotirios Fouzas1, Paul L P Brand
1Paediatric Respiratory Unit, Department of Paediatrics, University Hospital of Patras, Patras, Greece.
Insights
Predicting persistent asthma in preschoolers is difficult. Current asthma predictive index (API) tools have limitations and insufficient validation, making long-term outcome prediction challenging, especially in high-risk children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Preschool wheezing represents diverse conditions, complicating asthma risk identification.
- Predictive rules using clinical and lab parameters, like the asthma predictive index (API), are used clinically.
Purpose of the Study:
- To review current asthma predictive models for preschool wheeze.
- To evaluate the validity and performance of these models in predicting long-term asthma persistence.
Main Methods:
- Literature review of asthma predictive models.
- Analysis of model validity and performance characteristics.
- Assessment of predictive ability in general and high-risk preschool populations.
Main Results:
- Existing asthma predictive tools, including API, have practical and intrinsic limitations.
- These models demonstrate insufficient validation for widespread clinical application.
- Predictive accuracy for long-term outcomes is limited, particularly in high-risk children.
Conclusions:
- Simple clinical models are insufficient for accurately predicting asthma persistence in preschool children.
- The complex nature of asthma hinders reliable prediction based on current simple models.
- Further research is needed to improve prediction of persistent asthma in high-risk preschoolers.
Abstract:
Since preschool wheezing is the common expression of several heterogeneous disorders, identification of children at risk for persistent asthma is particularly challenging. To date, efforts to predict the outcome of preschool wheeze have mainly relied on predictive rules consisting of simple clinical and laboratory parameters. Among these tools, the asthma predictive index (API) has been introduced in international guidelines and position papers and is recommended for use in clinical practice. This article reviews the currently available asthma predictive models focusing on their validity and performance characteristics. Although these tools are generally simple and easy to apply, they suffer important intrinsic and practical limitations and they have been insufficiently validated to allow for widespread use in clinical settings. We also present evidence that their ability to predict the long-term outcome of preschool wheeze is limited in general populations, and even poorer in high-risk children in which prediction of asthma persistence might have important clinical and prognostic implications. Due to the complex and multifactorial nature of asthma, prediction of asthma persistence based on simple clinical models is practically impossible.
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