Asthma Predictive Index (API) for Children
Identifies young children (< 3 years) with wheezing who are at high risk of persistent asthma by school age. Validated in the Tucson Childrens Respiratory Study cohort.
Score interpretation
API negative -- low probability of persistent asthma by school age
→ Reassurance: most early wheezers do not have persistent asthma; transient infantile wheeze likely if no atopy; avoid unnecessary inhaled corticosteroid (ICS) use; viral-induced wheeze: salbutamol MDI + spacer for acute episodes; re-evaluate if pattern changes; education: difference between viral wheeze and asthma; no prophylactic ICS indicated; follow-up at 12 months or sooner if concerned.
API positive -- high probability (approximately 77%) of persistent asthma by school age
→ Discuss asthma likelihood with family; inhaled corticosteroid trial: beclometasone dipropionate (BDP) 100-200 mcg/day via spacer (or equivalent); LABA NOT indicated in < 5 years; reliever: salbutamol 100 mcg pMDI via spacer 1-2 puffs PRN; allergy referral for sensitisation workup; skin prick testing if not done; peak flow monitoring (> 5 years); written asthma action plan; school/nursery asthma plan; annual review with paediatric respiratory team; refer to paediatric respiratory if poor control on step 2.
Interpretation bands for the Asthma Predictive Index. Apply clinical judgement and local guidance.
References
- Castro-Rodriguez JA et al. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med. 2000;162(4):1403-1406.
- NICE NG80. Asthma: diagnosis, monitoring and chronic asthma management. NICE. 2017 (updated 2021).
Related
Curated clinical cross-links plus same-class fallbacks.
- Salbutamol (Paediatric — Asthma/Wheeze) · Short-Acting Beta-2 Agonist (SABA)
- Ibuprofen (Paediatric) · NSAID / Analgesic / Antipyretic
- Paracetamol (Paediatric) · Analgesic / Antipyretic — First-Line Pain and Fever in Children
- Morphine (Paediatric) · Opioid Analgesic — Moderate to Severe Pain in Children
- Prednisolone (Paediatric) · Corticosteroid — Asthma Exacerbation / Croup / Nephrotic Syndrome / IBD
- Montelukast (Paediatric) · Leukotriene Receptor Antagonist — Asthma Prophylaxis / Allergic Rhinitis
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.