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Usefulness of asthma predictive index in ascertaining asthma status of children using medical records: An explorative
C-I Wi1,2, E A Krusemark1,2, G Voge1,2,3
1Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
Insights
Frequent wheezing in children, defined by the Asthma Predictive Index (API), may need broader criteria. Wheezing episodes within 3 years, not just 1 year, should be considered for diagnosing childhood asthma retrospectively.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Epidemiology
Background:
- The original Asthma Predictive Index (API) defines frequent wheezing based on parental reports within the first three years of life.
- The pattern of frequent wheezing in children over three years old remains understudied.
- This study aimed to define frequent wheezing using medical records for asthma diagnosis in children.
Purpose of the Study:
- To assess wheezing frequency and intervals in children using medical records.
- To evaluate the definition of frequent wheezing for diagnosing asthma retrospectively.
- To explore if longer wheezing intervals impact asthma risk factor distribution.
Main Methods:
- Retrospective analysis of medical records from 427 children in a previous study.
- Included children with ≥2 wheezing episodes and API criteria (1 major or 2 minor).
- Compared risk factors between children with consecutive wheezing episodes at intervals ≤1 year versus 1-3 years.
Main Results:
- 62 children met API criteria at a median age of 2.3 years.
- 198 wheezing episodes were observed during follow-up (median age 11.3 years).
- 81% of wheezing intervals were within 3 years, with 60% within 1 year; risk factors were similar across intervals.
Conclusions:
- Frequent wheezing episodes occurring within a 3-year interval should be considered for asthma diagnosis when using the API retrospectively.
- The current definition of frequent wheezing in the API may need expansion.
- Further prospective studies with larger cohorts are recommended to validate these findings.
Background:
Frequent wheezing in original asthma predictive index (API) was defined by parental report of recurrent wheezing within 1 year during the first 3 years of life. The nature of frequent wheezing in children, particularly aged over 3 years, has not been studied. We aimed to assess the frequency and interval of wheezing to define frequent wheezing in ascertaining asthma for children using medical records.
Methods:
Among children who participated in a previous study (n = 427), all wheezing episodes documented in medical records were collected for children who had ≥2 wheezing episodes PLUS met one major criterion or two minor criteria of API. We compared the distribution of known risk factors for asthma between subjects having two consecutive wheezing episodes with shorter interval (≤1 year) compared to those with longer interval (1 to 3 years).
Results:
A total of 62 children met API at median age of 2.3 years. During follow-up period (median age: 11.3 years), a total of 198 wheezing episodes were observed. 81% of wheezing intervals were within 3 years from the earlier wheezing episode, including 60% within 1 year. Children who met API based on 1-year interval (n = 40) vs 1- to 3-year interval (n = 13) appeared to be similar in regard to the known risk factors for asthma.
Conclusions:
Our exploratory study finding suggests that children who had frequent wheezing episodes with longer interval (<3 years) need to be considered to be determined as asthma cases when API is applied to retrospective medical records. Prospective studies with a larger sample size need to replicate this finding.
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