Most wheezing during the first 3 years of life is related to viral respiratory infections. Respiratory viruses and symptoms of early asthma may be hard to tell apart, making diagnosis and treatment tricky. But doctors and parents now have a tool to help them predict with reasonable accuracy if the child will develop asthma or simply outgrow it.
The asthma predictive index (API) is a guide to determining which small children will likely have asthma in later years. Children younger than 3 years who have had 4 or more significant wheezing episodes in the past year are much more likely to have persistent (ie, lifelong) asthma after 5 years if they have either of the following:
One major decisive factor
- Parent with asthma
- Physician diagnosis of eczema (atopic dermatitis)
- Sensitivity to allergens in the air (as determined by physician through positive skin tests or blood tests to allergens such as trees, grasses, weeds, molds, or dust mites)
Two minor decisive factors
- Food allergies
- Greater than 4% blood eosinophils (a type of white blood cell often seen in allergic disease)
- Wheezing apart from colds
The API was developed after following almost 1,000 children through 13 years of age. It turned out that a wheezy child with a positive API at around 2 to 3 years of age meant there was about an 80% chance that child would have a definite diagnosis of asthma when entering first grade.
Using the API, doctors and parents can watch more closely for symptoms of asthma as the child grows and if needed, start the right medications earlier. Earlier and better treatment can help keep children active and healthy, and their asthma in good control.