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.