a presentation by me done on occasion of world asthma day 2018 may . in Tripoli children hospital

1. Hisham Alrabty 2018

2. Hisham Alrabty 2018

3. By Dr Hisham Alrabty
Pediatrics consultant and pulmonologist

4. Index:
Introduction.
API development.
Other indices.
Interpretation.
API advantages.
API pitfalls.
Final message.
Hisham Alrabty 2018

5. Introduction:
Pediatric asthma is still swinging between
over and under diagnosis because many
factors among them there is a lot of causes
for recurrent wheeze in infants and there is no
a single blood or imaging or even genetic test
considered diagnostic till now so asthma is
still clinically diagnosis certainly in infants
which lead some researchers to develop a tool
so called asthma predictive index.
Hisham Alrabty 2018

6. API development:
In 2000, Rodriguez et al ,the API was developed using
data from 1246
children in the Tucson Children’s Respiratory Study
birth cohort.
It was based on factors that were found
during the first 3 years to predict asthma at school age
(15 years).
There are two indices stringent and loose API.
Hisham Alrabty 2018

7. Other indices:
After the API was created, other scores
were developed to
predict which preschoolers with recurrent
wheezing would have
asthma at school age.
Hisham Alrabty 2018

8. In 2003, Kurukulaaratchy et al16 used data
from 1456 children in the Isle of Wight birth cohort
to devise
a scoring system based on 4 factors:
family history of asthma, recurrent
chest infections in the second year of life, atopic
sensitization at 4 years of age, and absence of
recurrent nasal symptoms in the first year of life.
These factors confer a high risk for wheezing
persistence at 10 years of age.
Hisham Alrabty 2018

9. In 2008, Devulapalli et al17 performed a
nested case-control study of 449 children in
Norway and created a simple scoring system
based on obstructive airway disease scores:
scores of 5 or greater (range, 1-12) by 2
years of age are a risk factor for asthma
at 10 years of age.
Hisham Alrabty 2018

10. In 2009, Caudri et al18 developed a clinical
scoring system using data from 3963 children from
the Prevention and Incidence of Asthma and Mite
Allergy (PIAMA) birth cohort in The Netherlands,
in which participants were assessed on a yearly basis
until the age of 8 years.
Using data from a subgroup of children with
reported wheezing or coughing at night (without
a cold) until 4 years of age, they assessed possible
predictors for asthma at 7 to 8 years of age.
Hisham Alrabty 2018

11. Hisham Alrabty 2018
Stringent API: More than 3 episodes of wheezing per year
during the first 3 years of life and 1 major or 2 minor criteria.
Loose API: Fewer than 3 episodes of wheezing per year and 1
major or 2 minor criteria.
Major Criteria Minor Criteria
1. Asthma in a parent,
documented by a physician.
2. Eczema in the child,
documented by a physician.
1. Allergic rhinitis in the child,
documented by a physician.
2. Wheezing apart from colds,
reported by the parents.
3. Peripheral eosinophilia
greater than or equal to 4%.
Asthma predictive index

12. Interpretation:
Stringent API: means child is mostly
asthmatic and needs regular follow up
in specialized clinic and prophylactive
treatment.
Loose API: means child needs further
work up to recognize cause of his
recurrent wheeze.
Hisham Alrabty 2018

13. Advantages:
 Noninvasive.
 Simple.
 Inexpensive.
 Useful tool for juniors.
 Identify wheezers who will become asthmatics
later.
Hisham Alrabty 2018

14. Pitfalls of API:
Predictive and not diagnostic.
Ignoring other causes of recurrent
wheeze in infants like GERD and CMA
so misdiagnosis could happen.
Needs further evaluation and
modification to make it more clinically
applicable and useful.
Hisham Alrabty 2018

15. Final message:
 Pediatric asthma is still clinical diagnosis.
 Asthma can happen in infants less than 1 year old
conditioned that exclusion of other causes of
recurrent wheeze like GERD.
 Till now there is no global consensus about
diagnosing asthma in children so it is matter of
clinical practice and high medical sense of
prediction.
 API useful tool for juniors and who still have
doubt about asthma in infants.
Hisham Alrabty 2018

16. Hisham Alrabty 2018