title: Optimum predictors of childhood asthma: persistent wheeze or the Asthma Predictive Index?
abstract: BACKGROUND
  The Asthma Predictive Index (API) and persistent wheezing phenotypes are associated with childhood asthma, but previous studies have not assessed their ability to predict objectively confirmed asthma.
  
  
  OBJECTIVE
  To determine whether the University of Cincinnati API Index (ucAPI) and/or persistent wheezing at age 3 can accurately predict objectively confirmed asthma at age 7.
  
  
  METHODS
  Data from the Cincinnati Childhood Allergy and Air Pollution Study, a high-risk prospective birth cohort, was used. Asthma was defined as parent-reported or physician-diagnosed asthma objectively confirmed by a change in FEV1 of ≥12% after bronchodilator or a positive methacholine challenge (PC20 ≤ 4 mg/mL); or as prior treatment with daily asthma controller medication(s). Multivariate logistic regression was used to investigate the relationship between confirmed asthma at age 7 and a positive ucAPI (adapted and modified from prior published API definitions) and persistent wheezing at age 3.
  
  
  RESULTS
  At age 7, 103 of 589 children (17.5%) satisfied the criteria for asthma. Confirmed asthma at age 7 was significantly associated with a positive ucAPI (adjusted odds ratio [aOR] 13.3 [95% CI, 7.0-25.2]; P < .01) and the persistent wheezing phenotype (aOR 9.8 [95% CI, 4.9-19.5]; P < .01) at age 3. Allergic persistent wheezing was associated with a significantly higher risk of asthma (aOR 10.4 [95% CI, 4.1-26.0]; P < .01) than nonallergic persistent wheezing (aOR 5.4 [95% CI, 2.04-14.06]; P < .01).
  
  
  CONCLUSIONS
  Both a positive ucAPI and persistent wheeze at age 3 were associated with objectively confirmed asthma at age 7; however, the highest risk was associated with ucAPI. These results demonstrate the ucAPI as a clinically useful tool for predicting future asthma in school-age children.
authors.affiliation: Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Priyal
authors.initials: P
authors.lastname: Amin
authors.affiliation: Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Linda
authors.initials: L
authors.lastname: Levin
authors.affiliation: Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Internal Medicine, Cincinnati Veteran's Affairs Medical Center, Cincinnati, Ohio.
authors.forename: Tolly
authors.initials: T
authors.lastname: Epstein
authors.affiliation: Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio; Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Pat
authors.initials: P
authors.lastname: Ryan
authors.affiliation: Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Grace
authors.initials: G
authors.lastname: LeMasters
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Gurjit
authors.initials: G
authors.lastname: Khurana Hershey
authors.affiliation: Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Tina
authors.initials: T
authors.lastname: Reponen
authors.affiliation: Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Manuel
authors.initials: M
authors.lastname: Villareal
authors.affiliation: Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio; Division of Pulmonary Medicine, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: James
authors.initials: J
authors.lastname: Lockey
authors.affiliation: Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio. Electronic address: BERNSTDD@ucmail.uc.edu.
authors.forename: David I
authors.initials: DI
authors.lastname: Bernstein
mesh_terms: D000367:Age Factors; D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D001985:Bronchial Provocation Tests; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010641:Phenotype; D011237:Predictive Value of Tests; D012008:Recurrence; D012135:Respiratory Sounds / Q000175:diagnosis* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Asthma; Asthma Predictive Index; Asthma prediction; Atopic persistent wheezing; Childhood asthma; Nonatopic persistent wheezing; Persistent wheezing; Wheezing phenotypes