Evaluation of the Modified Asthma Predictive Index in High-Risk Preschool Children
Evaluation of the Modified Asthma Predictive Index in High-Risk Preschool Children
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DOI：
10.1016/j.jaip.2012.10.008
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发表时间：
2013-03-01
影响因子：
9.4
通讯作者：
Jackson, Daniel J.
中科院分区：
文献类型：
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作者：
Chang, Timothy S.;Lemanske, Robert F., Jr.;Jackson, Daniel J.
背景：事实证明，预测学龄前儿童随后的学龄哮喘具有挑战性。 目的：在事后分析中确认改良哮喘预测指数 (mAPI) 在高风险人群和理论上未经选择的人群中的预测能力。我们还在相同人群中测试了具有 2 次喘息发作要求 (m(2)API) 的潜在 mAPI 修改。 方法：有过敏和/或哮喘家族史的受试者 (n = 289) 被用来预测 6 岁、8 岁和 11 岁时的哮喘，并利用生命前 3 年收集的特征。测试了 mAPI 和 m2API 的预测价值。结果：对于 mAPI 和 m2API，学龄哮喘预测从 1 岁到 3 岁有所改善。 mAPI 对 6、8 和 11 岁时的哮喘发展具有较高的预测价值（阳性似然比范围为 4.9 至 55）。将喘息发作次数减少至 2 (m(2)API) 会降低阳性检测后的预测值（阳性似然比范围为 1.91 至 13.1），而不会显着提高阴性检测的预测值。在未选择的人群和高风险人群中，mAPI 阳性的后测概率分别达到 72% 和 90%。结论：在高风险人群中，mAPI 阳性大大增加了未来哮喘的概率（例如，30% 的前测概率到 90% 的后测概率），并且是 m(2)API 的首选预测测试。凭借其更有利的测试后阳性概率，mAPI 可以帮助评估学龄前儿童未来哮喘风险的临床决策。 (C) 2013 年美国过敏、哮喘和免疫学学会。
BACKGROUND: Prediction of subsequent school-age asthma during the preschool years has proven challenging.OBJECTIVE: To confirm in a post hoc analysis the predictive ability of the modified Asthma Predictive Index (mAPI) in a high-risk cohort and a theoretical unselected population. We also tested a potential mAPI modification with a 2-wheezing episode requirement (m(2)API) in the same populations.METHODS: Subjects (n = 289) with a family history of allergy and/or asthma were used to predict asthma at age 6, 8, and 11 years with the use of characteristics collected during the first 3 years of life. The mAPI and the m2API were tested for predictive value.RESULTS: For the mAPI and m2API, school-age asthma prediction improved from 1 to 3 years of age. The mAPI had high predictive value after a positive test (positive likelihood ratio ranging from 4.9 to 55) for asthma development at years 6, 8, and 11. Lowering the number of wheezing episodes to 2 (m(2)API) lowered the predictive value after a positive test (positive likelihood ratio ranging from 1.91 to 13.1) without meaningfully improving the predictive value of a negative test. Posttest probabilities for a positive mAPI reached 72% and 90% in unselected and high-risk populations, respectively.CONCLUSIONS: In a high-risk cohort, a positive mAPI greatly increased future asthma probability (eg, 30% pretest probability to 90% posttest probability) and is a preferred predictive test to the m(2)API. With its more favorable positive posttest probability, the mAPI can aid clinical decision making in assessing future asthma risk for preschool-age children. (C) 2013 American Academy of Allergy, Asthma & Immunology.