Major criteria for the modified API and other risk factors for asthma: findings in preschool‐aged outpatients attending different medical settings.

Background: The modified asthma predictive index (mAPI) includes three major criteria for predicting asthma after the preschool age in toddlers with ≥4 wheezing episodes in a year; i.e., having at least one asthmatic parent, a physician diagnosis of atopic dermatitis and allergic sensitization to at least one aeroallergen. The distribution of major mAPI criteria and other risk factors for asthma in preschool‐age children attending different clinical care settings has been scarcely investigated. Clinical and functional assessment of these settings could better characterize patients at risk for developing asthma. Aims: To compare the distribution of the major mAPI criteria together with clinical data and lung function in preschool‐aged outpatients attending the pediatric pulmonologist (PP) with those attending the general pediatrician (GP). Methods: In 100 outpatients (PP: 59, GP: 41) aged 49.9+14.2 months, M/F: 56/44, we assessed spirometry, respiratory resistance (Rrs) and reactance (Xrs) with the FOT technique, and skin prick tests for common allergens. Parents were asked to complete a questionnaire on their child's respiratory health including mAPI and familial and environmental data. Parent‐reported bronchodilator response was qualified as the time typically elapsed from the start of inhaled therapy with salbutamol to an observed relief of the child's dyspnea. Allergen sensitization was defined by at least one skin wheal of ≥ 3 mm. Results: When compared with GP‐patients, PP‐patients had fewer months on breastfeeding, higher BMI percentile (but similar cigarette‐smoke exposure), and their parents more frequently reported previous bronchiolitis, physician diagnosis of asthma, exercise‐induced respiratory symptoms and quicker relief after inhaled salbutamol. The proportion of subjects with ≥4 wheezing episodes in a year and at least one major mAPI criterion was higher in PP‐patients than in GP‐ patients; however, only parental asthma (but not allergen sensitization or atopic dermatitis) was more frequent in PP‐patients vs. those attending the GP. PP‐patients had poorer lung function (lower FEF25‐75 and Xrs and higher Rrs) and wider responses to salbutamol (DFEV1 and DRrs) than GP‐patients. In the whole population, Rrs and Xrs correlated better with FEF25‐75 than with FEV1. Conclusion: Whereas lung function distinguished preschool‐aged outpatients attending the pediatric pulmonologist from those attending the general pediatrician, only one major mAPI criterion (parental asthma) divided these two groups. Our data support the protective role of breastfeeding, and the negative influence of overweight and previous bronchiolitis. Among parent reports, a relatively quick relief after inhaled salbutamol could be considered when assessing risk factors for asthma in children with recurrent wheeze.