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Published on: August 7, 2017
Optimum predictors of childhood asthma: persistent wheeze or the Asthma Predictive Index?
Priyal Amin1, Linda Levin2, Tolly Epstein3
1Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Insights
The University of Cincinnati Asthma Predictive Index (ucAPI) effectively predicts objectively confirmed childhood asthma by age 7. A positive ucAPI at age 3 showed the highest risk for developing asthma later in childhood.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Epidemiology
Background:
- Childhood asthma is a significant health concern.
- The Asthma Predictive Index (API) and persistent wheezing are known indicators, but their predictive power for objectively confirmed asthma needs further evaluation.
Purpose of the Study:
- To assess the University of Cincinnati API (ucAPI) and persistent wheezing at age 3 for predicting objectively confirmed asthma at age 7.
- To compare the predictive accuracy of ucAPI and persistent wheezing phenotypes.
Main Methods:
- Utilized data from the Cincinnati Childhood Allergy and Air Pollution Study, a high-risk birth cohort.
- Defined objectively confirmed asthma using bronchodilator response, methacholine challenge, or controller medication use.
- Employed multivariate logistic regression to analyze the association between ucAPI/persistent wheezing at age 3 and asthma at age 7.
Main Results:
- 17.5% of children had confirmed asthma at age 7.
- A positive ucAPI (aOR 13.3) and persistent wheezing (aOR 9.8) at age 3 were significantly associated with asthma at age 7.
- Allergic persistent wheezing showed a higher risk (aOR 10.4) than nonallergic persistent wheezing (aOR 5.4).
Conclusions:
- Both ucAPI and persistent wheeze at age 3 predict objectively confirmed asthma at age 7.
- The ucAPI demonstrated the strongest association with future asthma development.
- The ucAPI is a valuable clinical tool for predicting asthma in school-aged children.
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.
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