Asthma predictive index as a useful diagnostic tool in preschool children: a cross-sectional study in Korea

Abstract

Background: It is challenging to diagnose asthma in preschool children. The asthma predictive index (API) has been used to predict asthma and decide whether to initiate treatment in preschool children.Purpose: This study aimed to investigate the association between questionnaire-based current asthma with API, pulmonary function, airway hyperreactivity (AHR), fractional expiratory nitric oxide (FeNO), and atopic sensitization in preschool children.Methods: We performed a population-based cross-sectional study in 916 preschool children aged 4–6 years. We defined current asthma as the presence of both physician-diagnosed asthma and at least one wheezing episode within the previous 12 months using a modified International Study of Asthma and Allergies in Childhood questionnaire. Clinical and laboratory parameters were compared between groups according to the presence of current asthma.Results: The prevalence of current asthma was 3.9% in the study population. Children with current asthma showed a higher rate of positive bronchodilator response and loose and stringent API scores than children without current asthma. The stringent API was associated with current asthma with 72.2% sensitivity and 82.0% specificity. The diagnostic accuracy of the stringent API for current asthma was 0.771. However, no intergroup differences in spirometry results, methacholine provocation test results, FeNO level, or atopic sensitization rate were observed.Conclusion: The questionnaire-based diagnosis of current asthma is associated with API, but not with spirometry, AHR, FeNO, or atopic sensitization in preschool children.

Is the predictive model for asthma development useful as a tool for diagnosing pediatric asthma?

“…In this study, the loose and stringent APIs had high negative predictive values (NPVs) of 98.7% and 98.6%, respectively but conversely had low positive predictive values (PPVs) of 12.7% and 14.1%. 8) The NPVs reported in this study were similar to those reported in the original study that showed the usefulness of the API; however, the PPVs in this study were lower. 9) In contrast, the API showed higher sensitivity and specificity in this study than in the original study; therefore, it can be considered applicable to patients with recurrent wheezing.…”

“…Therefore, the study conducted by Lee et al 8) published in the current issue reveals the association between current asthma, the API and other tests.…”

“…This study showed that the questionnairebased diagnosis of current asthma is fairly associated with the API, but not with spirometry, airway hyperreactivity (AHR), fractional expiratory nitric oxide, or atopic sensitization in preschool children. 8) This study seems to be limited by its crosssectional design and the small number of included current asthma patients. In addition, AHR or atopic sensitization tests were performed in a small number of asthma patients, making it difficult to draw conclu sions.…”

Testing the Asthma Predictive Index as a diagnostic tool in preschoolers: analysis of a longitudinal birth cohort

“…The same group demonstrated that using natural language processing (NLP) mining of electronic health records for API criteria allowed for the ascertainment of asthma in children 9 ; the NLP-API predicted asthma with sensitivity 86%, specificity 98%, PPV 88%, and NPV 98% 9 . Similarly, a cross-sectional study in 916 Korean preschoolers showed that questionnaire-defined asthma was associated with stringent API+ (sensitivity 72.2%, specificity 82%, PPV 14.1%, NPV 98.6%, and 77% accuracy), but not with spirometry, airway hyperreactivity, exhaled nitric oxide, or atopic sensitization 6 . The authors speculated that the API may serve as a more reliable tool than those tests for the diagnosis of asthma in preschoolers; they also compared the API to other predictive models for asthma, and the API had higher LR+ and lower LR-6 .…”

“…The API has a compelling positive likelihood ratio (LR˜7.4 when applied by 3 years of age, for predicting a diagnosis of asthma by age 6), making it helpful in the identification of children at high risk for asthma; but its negative LR (˜0.75) is less helpful in ruling out the risk of incident asthma 4 . A recent cross-sectional study in preschoolers reported that the questionnaire-based diagnosis of asthma is associated with a positive API 6 . Our hypothesis is that the API could be used as a surrogate for asthma diagnosis in preschoolers from a longitudinal birth cohort.…”