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Testing the Asthma Predictive Index as a diagnostic tool in preschoolers: analysis of a longitudinal birth cohort
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  • Jose Castro-Rodriguez,
  • Erick Forno,
  • Oslando Padilla,
  • Paola Casanello,
  • Bernardo Krause,
  • Arturo Borzutzky
Jose Castro-Rodriguez
Pontificia Universidad Catolica de Chile
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Erick Forno
Children's Hospital Pittsburgh
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Oslando Padilla
Pontificia Universidad Católica de Chile
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Paola Casanello
Pontifical Catholic University of Chile
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Bernardo Krause
Pontifical Catholic University of Chile
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Arturo Borzutzky
Pontificia Universidad Catolica de Chile
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Abstract

Diagnosing asthma in preschool children remains an unsolved challenge, at a time when early identification would allow for better education and treatment to prevent morbidity and lung function deterioration. Objective: To evaluate if the Asthma Predictive Index (API) can be used as surrogate for asthma diagnosis in preschoolers. Methods: Birth cohort of 339 pregnant women enrolled at delivery and their offspring, who were followed for atopy, wheezing, and other respiratory illnesses through 30 months of age. The API was determined at 30 months of age by the researchers; and examined its association with physician-diagnosed asthma during the first 30 months, made independently by the primary care physician not involved in the study. Results: Among 307 offspring with complete follow-up, 44 (14.3%) were API+. Maternal body mass index, maternal education, past oral contraceptive use, birthweight, placenta weight, age of daycare at 12m, gastroesophageal reflux disease at 12m, acute otitis media at 18m, bronchiolitis, croup and pneumonia, cord blood adiponectin were all associated with API+. In the multivariable analysis, API+ was associated with almost 6-fold odds of asthma diagnosis (adjusted OR= 5.7, 95% CI [2.6-12.3]), after adjusting for the relevant covariates above including respiratory infections like bronchiolitis and pneumonia. The API sensitivity was 48%, specificity 92%, 61% PPV, 88% NPV, 6.4 LR+, 0.56 LR-, 0.84 diagnosis accuracy. The adjusted odds for asthma was 11.4. Conclusions: This longitudinal birth cohort suggests, for first time, that API could be used as a diagnostic tool, not only as a prognostic tool, in toddlers and preschoolers.

Peer review status:IN REVISION

23 Apr 2021Submitted to Pediatric Pulmonology
23 Apr 2021Assigned to Editor
23 Apr 2021Submission Checks Completed
28 Apr 2021Reviewer(s) Assigned
25 May 2021Review(s) Completed, Editorial Evaluation Pending
30 May 2021Editorial Decision: Revise Minor