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Clin Exp Pediatr > Accepted Articles
DOI: https://doi.org/10.3345/kjp.2019.00640    [Accepted]
Published online November 8, 2019.
Asthma Predictive Index as a useful diagnostic tool in preschool children: a cross-sectional study in Korea
Dong Hyeon Lee1, Ji-Won Kwon2, Hyung Young Kim3, Ju-Hee Seo4, Hyo-Bin Kim5, So-Yeon Lee6, Gwang-Cheon Jang7, Dae-Jin Song8, Woo Kyung Kim9, Young-Ho Jung6, Soo-Jong Hong6, Jung Yeon Shim1 
1Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
2Department of Pediatrics, Seoul National University Bundang Hospital, Sungnam, Republic of Korea
3Department of Pediatrics, Pusan National University Yangsan Hospital, Pediatrics, Yangsan, Republic of Korea
4Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea
5Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
6Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
7Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Ilsan, Republic of Korea
8Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
9Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
Correspondence: 
Jung Yeon Shim, Tel: +82-2-2001-2484, Fax: +82-2-2001-2199, Email: jy7.shim@samsung.com
Soo-Jong Hong, Tel: +82-2-3010-3379, Fax: +82-2-473-3725, Email: sjhong@amc.seoul.kr
Received: 13 June 2019   • Revised: 26 October 2019   • Accepted: 3 November 2019
Abstract
Background
Diagnosis of asthma in preschool children are challenging. The Asthma Predictive Index (API) is being used as a tool to predict asthma and decide whether to initiate treatment in preschool children.
Purpose
The aim of this study was to investigate the association of questionnaire-based current asthma with the API, pulmonary function, airway hyperreactivity (AHR), fractional expiratory nitric oxide (FeNO), and atopic sensitization in preschool children.
Methods
We performed a population-based, cross-sectional study in preschool children aged 4-6 years. We defined current asthma as the presence of both physician-diagnosed asthma and at least one wheezing episode within the last 12 months in a modified International Study of Asthma and Allergies in Childhood questionnaire. We enrolled 916 children. Clinical and laboratory parameters were compared between groups according to the presence of current asthma.
Results
The prevalence of current asthma was 3.9% in our study population. Children with current asthma showed a higher rate of positive bronchodilator response and loose and stringent APIs than did children without current asthma. The stringent API was associated with current asthma with 72.2% sensitivity and 82.0% specificity. The diagnostic accuracy of the stringent API for current asthma was 0.771. However, no difference in spirometry results, methacholine provocation test results, fractional expiratory nitric oxide level, and atopic sensitization rate were observed between the two groups.
Conclusions
The questionnaire-based diagnosis of current asthma is associated with the API, but not with spirometry, AHR, FeNO, and atopic sensitization in preschool children.
Key Words: Asthma, Child, Preschool, Wheezing, allergy, Diagnosis




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