ToolsCalculators
Modified Asthma Predictive Index (mAPI)
Predicts likelihood of persistent childhood asthma in young children with recurrent wheeze.
Modified Asthma Predictive Index (mAPI)
≥4 wheezing episodes in the past year (≥1 physician-diagnosed), or any wheezing in infancy
Major criterion: parental history of asthma
Major criterion: physician-diagnosed atopic dermatitis (eczema)
Major criterion: allergic sensitization to ≥1 aeroallergen
Minor criterion: allergic sensitization to milk, egg, or peanut
Minor criterion: wheezing episodes apart from colds
Minor criterion: blood eosinophilia ≥4%
ResultNegative mAPI
Wheezing frequency criterion not met; the mAPI is applied only to children with frequent wheeze.
- Major criteria met
- 0/3
- Minor criteria met
- 0/3
When to use
- A child ≤3 years old with recurrent wheezing episodes, to estimate the likelihood of asthma persisting into later childhood.
Formula
mAPI positive requires frequent wheezing (≥4 episodes/year, ≥1 physician-diagnosed) PLUS ≥1 major criterion (parental asthma, physician-diagnosed eczema, aeroallergen sensitization) OR ≥2 minor criteria (food allergen sensitization, wheeze apart from colds, blood eosinophilia ≥4%). The modified index replaces the original API's allergic-rhinitis minor criterion with food-allergen sensitization.
Pearls and pitfalls
- Derived from the PEACE/CAMP cohorts as a modification of the Castro-Rodriguez Asthma Predictive Index.
- The major/minor combination rule is an OR, not an AND: meeting either ≥1 major criterion or ≥2 minor criteria (in addition to frequent wheeze) is sufficient for a positive mAPI.
References
- Guilbert TW, Morgan WJ, Zeiger RS, et al. Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma. J Allergy Clin Immunol. 2004;114(6):1282-1287.
- Chang TS, Lemanske RF Jr, Guilbert TW, et al. Evaluation of the modified asthma predictive index in high-risk preschool children. J Allergy Clin Immunol Pract. 2013;1(2):152-156.