Predicting persistence of wheezing: one algorithm does not fit all

Abstract

Indeed, the current classification moves to the right direction by adopting a clinically meaningful way of thinking and avoiding unnecessary pathophysiological implications; PH owing to left heart disease (Group 2) and chronic thromboembolism (Group 4) are good examples. In this context, sarcoidosis, PLCH and LAM (Group 5.2) represent disorders that, according to the current evidence, are associated with PH mainly due to lung involvement and, therefore, we propose their inclusion in the third category (PH owing to lung disease and/or hypoxia) in any future classification scheme.

Characterizing wheeze phenotypes to identify endotypes of childhood asthma, and the implications for future management

“…[66] Our data suggest that at age 3 years, predictors of subsequent troublesome symptoms amongst children with wheezing were large total skin test wheal diameter (≥10mm), history of previous exacerbations, diminished lung function and current eczema.…”

“…Other strategies have been suggested that, although they do not have as good a predictive ability as the API, can be used as complementary approaches for identifying persistent wheeze endotypes. [66] The PIAMA study suggests 8 clinical parameters for the risk score: male sex, postterm delivery, parental education and inhaled medication, wheezing frequency, wheeze/dyspnoea apart from colds, respiratory infections, and eczema are independent factors to predict subsequent asthma.…”

Asthma predictive factors in infants with bronchiolitis: asthma risk at 13-20 years of age

“…MATRICARDI et al [1] presented an interesting comparison on the persistence of wheezing at 10-13 yrs of age between two birth cohorts from the UK and Germany. When the cohorts were re-evaluated by harmonising the data, family history of asthma, absence of recurrent rhinitis at ,1 yr, recurrent chest infections at ,2 yrs and atopic sensitisation at ,3-4 yrs were independent risk factors for wheezing at 10 years, with some differences between early life wheezers and non-wheezers [1].…”

“…In addition, treatment in hospital and outpatient clinics of hospitals enables assessment of more objective risk factors by virological and allergological examinations. The suggested hospitalised children's API (hAPI) consists of three major criteria (parental asthma, atopic dermatitis or food allergy in the child and sensitisation to inhaled allergens) and three minor criteria (sensitisation to food allergens, wheezing by viruses other than RSV and blood eosinophilia when healthy) [1,2]. In addition, parental smoking, maternal smoking in particular, further increases the asthma risk.…”

“…When the cohorts were re-evaluated by harmonising the data, family history of asthma, absence of recurrent rhinitis at ,1 yr, recurrent chest infections at ,2 yrs and atopic sensitisation at ,3-4 yrs were independent risk factors for wheezing at 10 years, with some differences between early life wheezers and non-wheezers [1]. When three or four of these risk factors were present, the algorithm was highly specific but not sensitive in predicting persistent wheezing at .10 yrs of age: sensitivity 0.53, specificity 0.85 and positive likelihood ratio 6.38 [1].…”