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Modified Asthma Predictive Index (mAPI)

Calculators  Respiratory
Modified Asthma Predictive Index (mAPI) is diagnostic tool by which risk of asthma in pediatrics can be estimated.
≥4 wheezing episodes/year
No 0
Yes 100
Parent with asthma
No 0
Yes 10
Patient has atopic dermatitis
No 0
Yes 10
Patient with aeroallergen sensitivity (ex: hay fever)
No 0
Yes 10
Wheezing unrelated to colds
No 0
Yes 1
Eosinophils ≥4% (on CBC)
No 0
Yes 1
Patient with allergy to milk, egg, or peanuts
No 0
Yes 1
Result:

Background

Measured Factor
Likelihood to develop asthma
Measured Factor Disease
  • Asthma
Measured Factor Detail
mAPI is effecient tool helpful for pediartrics which can assess the asthma occurence. A positive mAPI quantifies the increased probability of asthma occurence in children thus can be helpful in managing the asthma clinically at initial stage only.
Speciality
Pulmonologist
Body System
Respiratory
Measured Factor Low Impact
  • All boxes marked negatively indicates no chances of development of asthma by age 11
Measured Factor High Impact
  • If all boxes are marked positively then probability of development becomes 98% specific by age 11

Result Interpretation

Ranges Ranges
  • Critical High: Positive
  • Normal: Negative
  • Normal Adult Male: Negative
  • Normal Adult Female: Negative
  • Normal Pediatric: Negative
  • Normal Neonate Female: Negative
  • Normal Geriatric Male: Negative
  • Normal Geriatric Female: Negative
Result High Conditions
  • Asthma
Test Limitations
This index is applicable only when wheezing episodes are ≥4 per year
References: 2

Studies

Study Validation 1
The objective of this study was to assess the ability of the modified Asthma Predictive Index (mAPI) in predicting future asthma probability. A total of 289 subjects (age 6, 8, and 11 years) with a family history of allergy and/or asthma were recruited in the study.  Both mAPI and the m2API were calculated to get a predictive value. Results showed that mAPI  had high predictive value for asthma progression which was decreased if wheezing episodes were reduced to 2 (m2API). It confirmed that mAPI was more acceptable and reliable test than m2API thus can be applied clinically in decision making of asthma progression in prediartics
References: 3
Study Validation 2
The aim of the study was to predict the performance of Asthma Predictive Indices (API) in preschool children. A total of 1954 children from age 1 to 10 years were studied. Frequency of wheeze and API were evaluated and their correlation with asthma was assessed using logistic regression. Results showed that API had positive predictive values of 26% at age 7 year and odd ratios were 5.2. The discriminative ability for all prediction rules was moderate and overall prediction was low. This study concludes that API was not a powerful tool in predicting future of asthma in children so further improvements are required
References: 4
Study Additional 1
The aim of the study was to analyze the etiological factors in children with chronic cough. A total 563 children with chronic cough were involved in the study. The asthma diagnosis was done based on the patients’ symptoms and medical history, and was supported with laboratory findings. Modified Asthma Predictive Index (mAPI) and Global Initiative for Asthma (GINA) report 2014 were utilized in diagnosing the asthma. Results showed that psychogenic cough was the 2nd most common diagnosis in the children over 6 years of age. Asthma was present in 24.9% whereas asthma like symptoms were shown in 19 %. This study concluded that asthma and asthma-like symptoms were the most frequent diagnosis in children. Various age groups in children may have a different order of frequencies.
References: 5
Study Additional 2
This study focused to validate the mAPI and m2API in predicting the asthma diagnosis at 3 years of age. A total 416 subjects were involved in the study. Predictive values were determined by Child health questionnaires and clinical assessments. Performance for predictive indices was measured by binomial distribution and 95% confidence interval. Results showed that m2API was most sensitive (66.7% (95% Cl, 44.9-88.4) compared to physician-diagnosed asthma. Decrease in wheezing frequency had a negative impact on sensitivity of m2API and mAPI. This study concluded that m2API was most sensitive method of all however none of the method was accurate in diagnosing the asthma in children and further studies are warranted.
References: 6

References

  1. Guilbert TW, Morgan WJ, Zeiger RS, Mauger DT, Boehmer SJ, Szefler SJ et al. Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med. 2006;354(19):1985-97.
  2. Chang TS, Lemanske RF, Guilbert TW, et al. Evaluation of the modified asthma predictive index in high-risk preschool children. J Allergy Clin Immunol Pract. 2013;1(2):152-6.
  3. Chang TS, Lemanske RF, Guilbert TW, Gern JE, Coen MH, Evans MD, et al. Evaluation of the modified asthma predictive index in high-risk preschool children. J Allergy Clin Immunol Pract. 2013;1(2):152-6.
  4. Leonardi NA, Spycher BD, Strippoli MP, Frey U, Silverman M, Kuehni CE. Validation of the Asthma Predictive Index and comparison with simpler clinical prediction rules. J Allergy Clin Immunol. 2011;127(6):1466-72.e6.
  5. Gedik AH, Cakir E, Torun E, Demir AD, Kucukkoc M, Erenberk U, et al. Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm. Ital J Pediatr. 2015;41:73.
  6. Richelle, Jacqueline. "Wheezing in early life and validating the asthma predictive index." (2015).