Asthma Predictive Index (API)

API Calculator
≥4 Wheezing Episodes in Past Year
Major: Parent with Asthma
Major: Physician-Diagnosed Eczema
Major: Aeroallergen Sensitization
Minor: Food Allergen Sensitization
Minor: Wheezing Apart from Colds
Minor: Eosinophils ≥4%
Major + Minor Met: 0
Determines likelihood of pediatric patients developing childhood asthma.

Why Use

Clinicians may be more aggressive with trials of asthma medications in patients who are likely to be diagnosed with asthma later in life.

When to Use

Children/infants 3 years or younger with wheezing episodes.

Formula

Strict Criteria: ≥3 episodes of wheezing per year, AND ≥1 major criteria OR ≥2 minor criteria Loose Criteria: <3 episodes of wheezing per year, AND ≥1 major criteria OR ≥2 minor criteria

Pearls / Pitfalls

The Asthma Predictive Index (API) provides a method for predicting likelihood of a later diagnosis of asthma, similar to the Modified Asthma Predictive Index (mAPI) . The API is only relevant in young children with wheezing. While specificity is good, the score is not a good screening tool — it does not detect many patients who will later be diagnosed with asthma.

Advice

Consider that bronchodilators or steroids may be helpful in patients with respiratory illnesses, especially if they meet strict criteria for future asthma diagnoses.

More Information

In the derivation study: 59% of children with a positive loose index had active asthma at school age (defined at 15 years). 76% of those with a positive strict index had active asthma at school age (defined at 15 years).

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