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Sui H, Shen H, Zhang C, Wang M, Zhen Z, Zhang J. Elevated Saliva Pepsin Concentration as a Risk Factor for Asthma in Children with Allergic Rhinitis: A Preliminary Study. J Asthma Allergy 2024; 17:391-397. [PMID: 38681237 PMCID: PMC11048294 DOI: 10.2147/jaa.s447145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/08/2024] [Indexed: 05/01/2024] Open
Abstract
Objective This study aimed to explore whether saliva pepsin concentration (SPC) could be regarded as a risk factor for the occurrence and unfavorable control of asthma in children with allergic rhinitis. Methods A prospective study was conducted on a group of 20 consecutive children newly diagnosed with allergic rhinitis and asthma (referred to as the asthma group). All these children underwent fractional exhaled nitric oxide (FeNO) measurement, lung function tests, and assessment of asthma control using the 7-item Childhood Asthma Control Test (C-ACT) score. Simultaneously, a control group consisting of 20 children with simple allergic rhinitis, matched for baseline characteristics, was included. SPC measurement was performed in the two groups. Results The SPC value was significantly higher in the asthma group than that in the control group (165.0 ± 82.8 ng/mL vs 68.4 ± 34.5 ng/mL) (P < 0.001). In the asthma group, SPC was independently associated with FeNO, the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC), and forced expiratory flow at 50% and 75% of FVC (FEF50 and FEF75) (all P < 0.05). The severity of nasal symptoms evaluated by the visual analogue scale (N-VAS) was independently associated with FEF75, the maximal mid-expiratory flow (MMEF), and C-ACT score (P < 0.05). Conclusion Direct pepsin exposure and uncontrolled nasal symptoms may play crucial roles in the pathogenesis and progression of childhood allergic asthma. The SPC value can be considered as a risk factor for asthma in children with allergic rhinitis.
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Affiliation(s)
- Haijing Sui
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| | - Hong Shen
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| | - Chi Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| | - Minghui Wang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| | - Zhen Zhen
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| | - Junbo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China
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2
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Chu F, Kappel N, Akel M, Press VG, Alexander JT, Volerman A. Validity of the Childhood Asthma Control Test in diverse populations: A systematic review. Pediatr Pulmonol 2023; 58:1322-1336. [PMID: 36718492 PMCID: PMC10121871 DOI: 10.1002/ppul.26342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE We examined the validity of the Childhood Asthma Control Test (C-ACT) and identified recommended thresholds for uncontrolled asthma in children from varying backgrounds. METHODS A systematic literature review was performed utilizing PubMed, Ovid Medline, SCOPUS, CINAHL, and conference proceedings. Studies were included if they enrolled children, had a primary outcome of asthma control, examined test validity or psychometrics, and utilized the C-ACT. Along with study design and demographic data, we extracted all outcomes and comparisons used to validate the C-ACT. We evaluated risk of bias using the COSMIN Risk of Bias tool. Our protocol was registered with PROSPERO (CRD42020211119). RESULTS Of 4924 records screened, 28 studies were included. Studies were conducted internationally and published between 2007 and 2018. Average number of enrolled participants was 193 (SD = 155, range = 22-671). Ten studies calculated Cronbach's α (mean [SD] = 0.78(0.05), range = 0.677-0.83). Thirteen studies recommended cut-offs for uncontrolled asthma (≤18-≤24). Nine studies found significant agreement or correlation between C-ACT and Global Initiative for Asthma guidelines/physician assessment of asthma control (correlation coefficients range = 0.219-0.65). Correlation coefficients between C-ACT and spirometry were <0.6 in five of six studies that included spirometry. Kappa values for C-ACT and various spirometry measurements ranged 0.00-0.34. CONCLUSIONS The C-ACT showed good internal consistency and mixed levels of agreement and correlation with various clinical asthma measures. Recommended cut-offs for asthma control varied and had no consistent relationship with nationality, race, ethnicity, or language. Few studies examined cross-cultural validity and multiple populations remain under-studied.
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Affiliation(s)
- Francesca Chu
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Nicole Kappel
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Mary Akel
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Valerie G Press
- University of Chicago, Department of Medicine, Section of General Internal Medicine
- University of Chicago, Department of Pediatrics, Section of Academic Pediatrics
| | - Jason T Alexander
- University of Chicago, Department of Medicine, Section of General Internal Medicine
| | - Anna Volerman
- University of Chicago, Department of Medicine, Section of General Internal Medicine
- University of Chicago, Department of Pediatrics, Section of Academic Pediatrics
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3
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Tang MF, Leung ASY, Ngai NA, Chan OM, Wong GWK, Leung TF. Prospective study of disease persistence and lung function trajectories of childhood asthma. Pediatr Allergy Immunol 2022; 33:e13726. [PMID: 35212048 DOI: 10.1111/pai.13726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A proportion of asthmatic children outgrow their disease by adulthood, but there are limited data on predictors for asthma persistence. This prospective study characterized the trajectory of spirometric indices and identified predictors for the persistence of childhood asthma. METHODS Chinese asthmatic children aged 6-15 years from pediatric allergy clinic underwent annual visits for ≥5 years and until their adulthood. Pre-bronchodilator spirometry and anti-asthma medications were recorded at baseline and then at least annually. Asthma resolution was defined when patients were free from asthma symptoms and use of anti-asthma drugs for ≥2 years. Logistic regression was used to identify predictors for asthma persistence. Generalized estimating equation was used to analyze longitudinal changes in lung function parameters in relation to asthma persistence. RESULTS 181 asthmatic children aged [mean (SD)] 10.0 (2.7) years were followed for [mean (SD)] 12.5 (2.8) years. One third of them outgrew asthma during follow-up. Female was 3.36 times more likely to have persistent asthma. Inhaled corticosteroid (ICS) treatment ever and frequent asthma exacerbation (AE) predicted asthma persistence with respective odds ratios of 3.19 (95% confidence interval [CI] 1.44-7.09) and 3.05 (95% CI 1.39-6.68). Persistent asthma was inversely associated with baseline forced expiratory volume in 1-second (FEV1 %) with an odds ratio of 0.96 (95% CI 0.93-1.00). Throughout follow-up, patients with persistent asthma had generally lower forced expiratory indices than those with asthma resolution. Children with persistent asthma experienced poorer lung function growth. CONCLUSIONS Female, ICS ever, and frequent AE predicted persistent asthma. Patients with persistent asthma had lower forced expiratory indices and poorer lung function growth into adulthood.
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Affiliation(s)
- Man Fung Tang
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Agnes Sze Yin Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Noelle Anne Ngai
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Oi Man Chan
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Gary Wing Kin Wong
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong
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4
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Chen ZM, Zhao DY, Xiang L, Hong JG. Treatment of pediatric mild persistent asthma with low-dose budesonide inhalation suspension vs. montelukast in China. World J Pediatr 2021; 17:619-625. [PMID: 34613593 DOI: 10.1007/s12519-021-00464-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are limited studies comparing budesonide inhalation suspension (BIS) with montelukast in real-world settings where treatment adherence and persistency may be suboptimal. This real-world study aims to investigate the control effectiveness of montelukast or BIS as a monotherapy in Chinese children with mild asthma. METHODS Data were derived from a retrospective questionnaire-based analysis of 2‒14-year-old children with mild persistent asthma, who received either 500 µg of BIS (n = 153) or 4‒5 mg of montelukast (n = 240) once daily. The indicators of asthma control, the Asthma Control Test (ACT)/Childhood ACT (C-ACT) score, and the asthma-related medical costs were assessed. The differences between the two groups were compared using an unpaired t-test (normally distributed), Mann-Whitney U test (non-normally distributed) or chi-squared test (categorical variables). RESULTS Medication compliance in the past 3-month period was better in the montelukast group than in the BIS group (P = 0.042). The montelukast group exhibited better asthma control in the past 4-week period, including lower percentages of asthmatic children with symptoms more than twice a week (P = 0.021), had night waking or night coughing (P = 0.022), or required reliever medication more than twice a week (P < 0.001). The montelukast group had a lower percentage of children with an ACT/C-ACT score ≤ 19 (P = 0.015). Caregivers reported a significantly better exercise tolerance in the children who received montelukast vs. BIS in the past 12 months (P < 0.001). Significantly higher medical expenditures attributable to asthma in the past 12 months were observed in the BIS group vs. montelukast group (P < 0.001). CONCLUSION Both treatments provided acceptable overall asthma control in children with mild persistent asthma; however, more reliever medication and more medical expenditures attributable to asthma were needed for BIS vs. montelukast in real-world settings, where factors such as compliance were also taken into account.
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Affiliation(s)
- Zhi-Min Chen
- Department of Respiratory Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - De-Yu Zhao
- Department of Respiratory Diseases, Children's Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital, Capital Medical University, National Children's Hospital Center, Beijing, 100045, China
| | - Jian-Guo Hong
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiaotong University, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China.
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5
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Perron G, Garcia M, Carbonnel F, Trebuchon F, Daures JP, Amouyal M, Demoly P, Costa D. [The Childhood Asthma Control Test improves the therapeutic adaptations recommended for asthmatics aged 6 to 11 years in primary practice. A Randomized comparative prospective study]. Presse Med 2019; 48:e257-e266. [PMID: 31473028 DOI: 10.1016/j.lpm.2018.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/08/2018] [Accepted: 10/09/2018] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Asthma is the leading chronic disease of the child; control and treatment remain inadequate. Our objective was to assess whether the use of the Childhood Asthma Control Test (C -ACT) in primary care had an impact on adapting therapy. METHODS The study was quantitative prospective and compared 2 groups of general practioners. All had the same reminders about childhood asthma management. The C-ACT was detailed to one group only. Doctors in the control group had to work as usual without C-ACT. Doctors included asthmatic children aged 6 to 11 years who were consulting for their asthma or any other reason. The primary endpoint was the adaptation of asthma treatment according to the Global Initative for Asthma (GINA). Evaluations of the control group were compared with the after consultation self-administered online C-ACT. RESULTS From April to October 2014, 61 physicians included 179 patients in two comparable groups. Although not significant statistically, doctors using C-ACT found 45% of uncontrolled asthma (vs. 31%). When the reason for consultation was not related to asthma, the figure was 25% (vs. 15%). Doctors using the C-ACT made twice less therapeutic adaptations not recommended by the GINA: 8% vs. 16%. 25% of evaluations of doctors in the control group were discordant with the internet C-ACT. After correction with the internet C-ACT of these imprecise initial assessments, the figure was 25%: 3 times more than in the C-ACT group (P=0.014). CONCLUSION The use in primary care of C-ACT should allow a better assessment of asthma control and adaptation of treatment in children.
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Affiliation(s)
- Guillaume Perron
- Université de Montpellier, departement de medecine generale, Montpellier, France
| | - Marc Garcia
- Université de Montpellier, departement de medecine generale, Montpellier, France
| | - François Carbonnel
- Université de Montpellier, departement de medecine generale, Montpellier, France
| | - Florence Trebuchon
- CHU de Montpellier, centre médical, chemin de Fescau, 34980 Montferrier-sur-Lez, France
| | - Jean-Pierre Daures
- Laboratoire de biostatistique, d'épidémiologie et de sante publique, IURC, EA2415, Montpellier, France
| | - Michel Amouyal
- Université de Montpellier et équipe EPAR, departement de medecine générale, Paris, France
| | - Pascal Demoly
- CHU, université de Montpellier et Sorbonne Université, Département de pneumologie & addictologie, UMR-S 1136, IPLESP, équipe EPAR, 75013 Paris, France.
| | - David Costa
- Université de Montpellier et équipe EPAR, departement de medecine générale, Paris, France
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Strömberg Celind F, Wennergren G, Vasileiadou S, Alm B, Åberg N, Goksör E. Higher parental education was associated with better asthma control. Acta Paediatr 2019; 108:920-926. [PMID: 30304579 PMCID: PMC6587735 DOI: 10.1111/apa.14610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/17/2018] [Accepted: 10/05/2018] [Indexed: 11/30/2022]
Abstract
Aim Inhaled corticosteroids have resulted in the improved control of asthma and a reduced need for hospitalisation. This study aimed to examine the prevalence of uncontrolled asthma and factors that affect asthma control. Methods The data came from a longitudinal cohort study of children. The parents answered questionnaires from age 6 months to 12 years. The response rate at age 12 years was 76% (3637/4777) and doctor‐diagnosed asthma was reported in 6.4% (n = 233). Asthma control was examined with the Asthma Control Test (ACT), where scores below 20 denote uncontrolled asthma. Results Of the children with asthma at age 12 years, 15% had an ACT value below 20, that is uncontrolled asthma. Independent risk factors for uncontrolled asthma were wheeze triggered by exercise (adjusted OR, aOR 5.6; 1.9–16.6), cat at home (aOR 3.5; 1.2–10.0) and current doctor‐diagnosed rhinitis (aOR 2.8; 95% CI 1.1–7.0). A higher education in the parents reduced the risk of uncontrolled asthma (aOR 0.3; 95% CI 0.1–0.8). Only six children (i.e. 2.6%) reported hospitalisation due to asthma during the last year. Conclusion Of the children with asthma, 15% had uncontrolled asthma. Higher education in the parents was associated with better asthma control in the children.
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Affiliation(s)
- Frida Strömberg Celind
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Göran Wennergren
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Styliana Vasileiadou
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Bernt Alm
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Nils Åberg
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Emma Goksör
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
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7
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Banasiak NC. Implementation of the Asthma Control Test in Primary Care to Improve Patient Outcomes. J Pediatr Health Care 2018; 32:591-599. [PMID: 30104128 DOI: 10.1016/j.pedhc.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Asthma is one of the major chronic diseases in the pediatric population, affecting 9.5% of children. The National Heart, Lung, and Blood Institute recommends the use of the Asthma Control Test (ACT) for periodic assessment of asthma control. The purpose of this evidence-based project was to implement the Asthma Control Test screening tool into the primary care practice to improve management of patients with asthma by more accurately addressing asthma control. METHODS The project was a pre- and post-implementation study comparing two different groups of patients with asthma seen at the clinic over 5-week periods. RESULTS After the implementation of the educational program and project, 82.6% of advanced practice registered nurses and 30.7% of pediatric resident physicians used an Asthma Control Test, resulting in identification of 9 (21%) patients who were considered not well-controlled. All (100%) of those children identified as not well-controlled through the Asthma Control Test received an adjustment in their medication therapy. CONCLUSIONS The Childhood ACT and ACT are simple, self-administered, validated questionnaires that can easily be incorporated into a primary care practice to assess the level of asthma control and to identify patients with asthma that is not well controlled.
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8
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AlTeneiji M, AlKalbani A, Nasser H, Iram D, Alblooshi A, Narchi H. Cross-sectional study assessing the performance of the Arabic translated childhood asthma control test. NPJ Prim Care Respir Med 2018; 28:41. [PMID: 30385757 PMCID: PMC6212419 DOI: 10.1038/s41533-018-0109-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/01/2018] [Indexed: 11/25/2022] Open
Abstract
The standard Arabic version of the Childhood Asthma Control Test (C-ACT) has never been previously evaluated in Arab countries. We studied its correlation in Arabic speaking children in the United Arab Emirates (UAE), with both the GINA assessment of asthma control and the resulting changes in asthma management. The Arabic C-ACT was completed by the children or by their parents when needed. A GINA based level of asthma control score was assigned by their managing physician. The correlation between the different cut- scores of the C-ACT and GINA were studied. A total of 105 eligible children with asthma (aged between 4 and 11.8 years, 61% boys) were enrolled. The Arabic translated C-ACT had a high reliability (Cronbach alpha 81%) and validity (as it correlated well with the GINA level of control). We found that using it with the traditional cut-score of 19 overestimated the degree of asthma control. Instead, a calculated optimal cut-score of 20 estimated more accurately the level of asthma control as assessed both by the GINA assessment and also by changes in asthma management. The current Arabic version of the C-ACT has a good reliability and validity. By using a single optimal cut-point of 20, it can be used to assess both the level of asthma control and of treatment control. It does not, however, accurately define asthma control when using the originally proposed cut-score of 19. Physicians need to recognise that the C-ACT cut-points may vary in different populations. We suggest that cut-scores of translated versions need to be modified in different geographical settings. The cut-off score suggestive of poor disease management in the Childhood Asthma Control Test (C-ACT) may need to be changed for different geographical populations. Majid AlTeneiji at Tawam Hospital in Al-Ain, and co-workers across the United Arab Emirates compared the performance of the Arabic version of the C-ACT with the global asthma control test, GINA, in verifying levels of asthma and treatment control. The researchers enrolled 105 children aged 4 to 11 who completed both tests. The Arabic C-ACT performed with high reliability and validity, but the team found that the original English cut-point score of 19, indicating poor disease management, should be raised to 20 in their Arabic population to improve test accuracy. AlTeneiji’s team suggest that the C-ACT test points system may need to be revised for different geographical settings around the world.
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Affiliation(s)
- Majid AlTeneiji
- Department of Pediatrics, Tawam Hospital in affiliations with Johns Hopkins Medicine, P.O.Box 15258, Abu Dhabi, United Arab Emirates.
| | - Alia AlKalbani
- Department of Pediatrics, Tawam Hospital in affiliations with Johns Hopkins Medicine, P.O.Box 15258, Abu Dhabi, United Arab Emirates
| | - Huda Nasser
- Department of Pediatrics, Tawam Hospital in affiliations with Johns Hopkins Medicine, P.O.Box 15258, Abu Dhabi, United Arab Emirates
| | - Durdana Iram
- Department of Pediatrics, Tawam Hospital in affiliations with Johns Hopkins Medicine, P.O.Box 15258, Abu Dhabi, United Arab Emirates
| | - Afaf Alblooshi
- Department of Pediatrics, College of Medicine and Health Science, United Arab Emirates University, P.O.Box 17666, Al-Ain, United Arab Emirates
| | - Hassib Narchi
- Department of Pediatrics, College of Medicine and Health Science, United Arab Emirates University, P.O.Box 17666, Al-Ain, United Arab Emirates
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9
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Hon KL, Bao YM, Chan KC, Chau KW, Chen RS, Cheok KTG, Chiu WK, Deng L, He CH, Ieong KM, Kung JSC, Lam P, Lam SYD, Lee QU, Lee SL, Leung TF, Leung TNH, Shi L, Siu KK, Tan WP, Wang MH, Wong TW, Wu BJ, Yip AYF, Zheng YJ, Ng DK. Determinants for asthma control, quality of life and use of complementary and alternative medicine in asthmatic pediatric patients in four cities. World J Pediatr 2018; 14:482-491. [PMID: 30047047 DOI: 10.1007/s12519-018-0167-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Asthma is a significant chronic health problem worldwide. Management aims at disease control by reducing functional impairment and exacerbations and improving quality of life (QoL). We report a multi-center study to survey asthma control and QoL in four cities in the Pearl River Delta. METHODS The conjoint survey involved ten Hong Kong pediatric hospitals/units, two Shenzhen hospitals, two Macau hospitals, and two Guangzhou hospitals on asthma control (using Asthma Control Test) and QoL (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ). Acceptability of a treatment is graded as very good/good/fair/poor. RESULTS Good asthma control was only reported in 80% subjects in Hong Kong, but higher in sister cities (85-94%, P < 0.001). Allergic rhinitis, "incense burning", and "smoker in family" were prevalent among the four cities. Logistic regression showed better control of asthma was associated with better PADQLQ (B = - 0.029, P < 0.001), better acceptability of bronchodilator (B = - 1.488, P = 0.025), negatively with "smoker in family" (B = - 0.83, P = 0.015) and various PADQLQ domains. Conversely, worse PADQLQ was associated with allergic rhinitis severity (B = 4.77, P < 0.001), poor control of asthma (B = 7.56, P < 0.001), increased frequency of traditional Chinese medicine use (B = 1.7, P < 0.05), increased frequency of bronchodilator usage (B = 1.05, P < 0.05), "smoker in family" (B = 4.05, P < 0.05), and incense burning at home (B = 3.9, P < 0.05). CONCLUSIONS There are some clinical and cultural differences among the four southern Chinese cities within the Guangdong province. This study identifies potentially modifiable environmental and treatment factors associated with poor asthma control and QoL for health-care interventions. Having a smoker in the family is independently associated with poor asthma control and QoL.
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Affiliation(s)
- Kam Lun Hon
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China.
| | - Yan Min Bao
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen, 518026, China
| | - Kate C Chan
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Kin Wai Chau
- Hong Kong Society of Pediatric Respirology and Allergy, Hong Kong SAR, China.,Pediatric Respiratory and Sleep Disorders Center, Room 1315D, Argyle Centre Phase 1, 688 Nathan Road, Mongkok, Kowloon, Hong Kong SAR, China
| | - Rong-Shan Chen
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | | | - Wa Keung Chiu
- Department of Pediatrics and Adolescent Medicine, United Christian Hospital, 130, Hip Wo Street, Kwun Tong, Hong Kong SAR, China
| | - Li Deng
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Chun-Hui He
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Kin Mui Ieong
- Department of Pediatrics, Central Hospital Conde S. Januario, Macau, China
| | - Jeng Sum C Kung
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Ping Lam
- Department of Pediatrics and Adolescent Medicine, Caritas Medical Center, 111, Wing Hong Street, Sham Shui Po, Hong Kong SAR, China
| | - Shu Yan David Lam
- Department of Pediatrics and Adolescent Medicine, Tuen Mun Hospital, 23 Tsing Chung Koon Road,Tuen Mun, New Territories, Hong Kong SAR, China
| | - Qun Ui Lee
- Department of Pediatrics and Adolescent Medicine, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong SAR, China
| | - So Lun Lee
- Department of Pediatrics and Adolescent Medicine, Queen Mary Hospital, 102, Pokfulam Road, Hong Kong SAR, China.,Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ting Fan Leung
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Theresa N H Leung
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chaiwan, Hong Kong SAR, China.,Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian, Shenzhen, China
| | - Lei Shi
- Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chaiwan, Hong Kong SAR, China
| | - Ka Ka Siu
- Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian, Shenzhen, China
| | - Wei-Ping Tan
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
| | - Maggie Haitian Wang
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.,JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tak Wai Wong
- Department of Pediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, 11, Chuen On Road, Tai Po, Hong Kong SAR, China
| | - Bao-Jing Wu
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Ada Y F Yip
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
| | - Yue-Jie Zheng
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen, 518026, China
| | - Daniel K Ng
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
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10
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Rhee H, Love T, Mammen J. Comparing Asthma Control Questionnaire (ACQ) and National Asthma Education and Prevention Program (NAEPP) asthma control criteria. Ann Allergy Asthma Immunol 2018; 122:58-64. [PMID: 30213611 DOI: 10.1016/j.anai.2018.09.448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/15/2018] [Accepted: 09/05/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adequate assessment of control is critical to asthma management. The Asthma Control Questionnaire (ACQ) and the National Asthma Education and Prevention Program (NAEPP) criteria are commonly used measures of asthma control. OBJECTIVE To examine the associations between the ACQ and NAEPP criteria and compare the validity in association with lung function, asthma exacerbation, and quality of life. METHODS The ACQ and the NAEPP criteria were administered to 373 adolescents with asthma aged 12 to 20 years. The 2 measures correlated with forced expiratory volume in 1 second (FEV1), asthma exacerbation (oral corticosteroid use, hospitalization, and emergency department [ED] use) in the past 12 months, and quality of life. RESULTS Agreement between the ACQ and NAEPP criteria was moderate (κ = 0.40-0.61). Neither of the 2 measures was a reliable predictor of FEV1 less than 80% because of the high rate of false-positive results for the ACQ (68%) and low sensitivity for the NAEPP (49%). The NAEPP identified more cases of uncontrolled asthma (84.6%) than the ACQ (64.6%). The ACQ was a significant predictor of recent oral corticosteroid use, hospitalization, and ED visits (area under the curve = 0.66, 0.66, and 0.64, respectively; P < .001), as was NAEPP (area under the curve = 0.63, 0.66, and 0.61, respectively; P < .001). Both measures were significantly associated with quality of life, and the associations were particularly strong for the ACQ (r = -0.87 for symptom subscale, r = -0.76 for activity subscale, and r = -0.78 for emotional function subscale). CONCLUSION Neither the ACQ nor the NAEPP appears to reliably predict lung function, whereas both measures reasonably associate with acute asthma exacerbation. The ACQ may be the superior measure in gauging the psychosocial effect of asthma control given its particularly strong associations with quality of life. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02293499.
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Affiliation(s)
- Hyekyun Rhee
- University of Rochester School of Nursing, Rochester, New York.
| | - Tanzy Love
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Jennifer Mammen
- University of Rochester School of Nursing, Rochester, New York
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11
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Burbank AJ, Todoric K, Steele P, Rosen J, Zhou H, Frye M, Loughlin CE, Ivins S, Mills K, Massey LD, Reeve BB, Hernandez ML. Age and African-American race impact the validity and reliability of the asthma control test in persistent asthmatics. Respir Res 2018; 19:152. [PMID: 30111326 PMCID: PMC6094875 DOI: 10.1186/s12931-018-0858-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/08/2018] [Indexed: 11/21/2022] Open
Abstract
Background The Asthma Control Test (ACT) is widely used to assess asthma control, yet the validity and reliability of the test have not been specifically evaluated in adolescents or African-Americans. We conducted a prospective psychometric study of the ACT in African-American (AA) and non-African-American (nAA) adolescents with persistent asthma, with emphasis on the clinical utility of the test for medical decision making. Methods Participants completed the ACT and performed spirometry. A physician conducted a guidelines-based assessment of asthma control, blinded to the ACT score. Study procedures were repeated 6–8 weeks later. The ACT-based asthma control assessment was compared to physician assessment. Results For baseline and follow-up visits, internal consistency, as measured using Cronbach’s alpha, was 0.80 and 0.81 in AA teens and 0.80 and 0.83 in nAA teens. Intraclass correlation coefficients were 0.59 and 0.76 in AA and nAA teens, respectively, with stable asthma control over time. Agreement between ACT and physician assessment was moderate in AA teens and fair in nAA teens. An ACT score of ≤19 showed reduced sensitivity for not well controlled asthma in both groups, while a score of ≤21 had the greatest area under the ROC curve. ACT scores were marginally responsive to change in control status. Conclusions Concerns for the ACT’s ability to detect uncontrolled asthma in adolescents emphasizes the need for a more comprehensive evaluation of asthma control in clinical settings. A higher threshold ACT score to define not well controlled asthma may be needed if the ACT is to be used for medical decision making. Trial registration ClinicalTrials.gov: NCT02671643, NCT02662413. Electronic supplementary material The online version of this article (10.1186/s12931-018-0858-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allison J Burbank
- Division of Pediatric Allergy, Immunology and Rheumatology, University of North Carolina, Chapel Hill, NC, USA. .,Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, 104 Mason Farm Road, Chapel Hill, NC, 27599-7310, USA.
| | - Krista Todoric
- Penn State Hershey Allergy, Asthma & Immunology, Hershey, PA, USA
| | - Pamela Steele
- Division of Pediatric Allergy, Immunology and Rheumatology, University of North Carolina, Chapel Hill, NC, USA
| | - Jonathan Rosen
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Haibo Zhou
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Marcia Frye
- Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Ceila E Loughlin
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, NC, USA
| | - Sally Ivins
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, 104 Mason Farm Road, Chapel Hill, NC, 27599-7310, USA
| | - Katherine Mills
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, 104 Mason Farm Road, Chapel Hill, NC, 27599-7310, USA
| | | | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michelle L Hernandez
- Division of Pediatric Allergy, Immunology and Rheumatology, University of North Carolina, Chapel Hill, NC, USA
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12
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Ip KI, Hon KL, Tsang KYC, Leung TNH. Steroid phobia, Chinese medicine and asthma control. CLINICAL RESPIRATORY JOURNAL 2017; 12:1559-1564. [PMID: 28876537 DOI: 10.1111/crj.12705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/14/2017] [Accepted: 09/01/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inhaled corticosteroids (ICS) are the mainstay of treatment for asthma. Corticosteroid (CS) phobia and fears are prevalent, and these may influence therapeutic efficacy and asthma control. AIM The aim of this study was to evaluate if CS fear is associated with asthma control in children. METHODS Patients aged >4 years with asthma at a pediatric outpatient clinic were surveyed, and the Asthma Control Test (ACT) was used for the assessment of asthma control. RESULTS Ninety-eight patients and their parents were interviewed. Thirty-four (35%) parents reported moderate or significant CS fear. They were more likely than those with no or little fear to have poorer asthma control (mean ACT scores 21.3 ± 4.0 vs 23.1 ± 3.3, P = 0.02), discuss their fears with their doctors (P < 0.001), request CS sparing medications (P = 0.044) and resort to Chinese medicine (CM) usage (P < 0.001). Backward binomial logistic regression showed parents with moderate/significant fears were more likely to discuss their fears with their doctors (OR: 5.21; 95% CI: 1.86-14.59; P = 0.002) and have used CM (OR: 4.28; 95% CI: 1.61-11.41; P = 0.004). CS fear was not translated to reduced self-reported compliance in the prescribed ICS. About 40% of the respondents had ever used Chinese Medicine (CM) with 82% of the users reported having used Chinese herbal medicine and 49% had used cold moxibustion. CONCLUSIONS CS fear and CM usage are prevalent. Parents with CS fear were more likely to have children with poorer asthma control and have used Chinese medicine. Physicians caring for children with asthma should be aware of parents with CS fear, prepared to address the fear or concerns and offer evidence-based alternative treatment.
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Affiliation(s)
- Ka Ian Ip
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, People's Republic of China
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kathy Yin Ching Tsang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Theresa Ngan Ho Leung
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, People's Republic of China.,Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong SAR, People's Republic of China
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13
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Xiang L, Zhao J, Zheng Y, Liu H, Hong J, Bao Y, Chen A, Deng L, Ji W, Zhong N, Shen K. Uncontrolled asthma and its risk factors in Chinese children: A cross-sectional observational study. J Asthma 2016; 53:699-706. [PMID: 27043467 DOI: 10.3109/02770903.2016.1144199] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma afflicts many children in China but information about asthma management among Chinese pediatric asthma patients is limited. This study aims to evaluate asthma control among Chinese pediatric patients and identify risk factors associated with uncontrolled asthma. METHODS A total of 4223 patients with persistent asthma aged 2-16 years from 42 tertiary hospitals across all regions of mainland China except Tibet were surveyed. Asthma Control Test (ACT), Childhood Asthma Control Test (C-ACT) and Global Initiative for Asthma (GINA) criteria were used to assess asthma control for children aged 12-16 years, 4-11 years and 2-3 years, respectively. Uncontrolled asthma was defined as ACT or C-ACT score ≤19 or GINA-defined uncontrolled asthma. Risk factors associated with uncontrolled asthma were identified using multivariate logistic regression models. RESULTS Asthma was uncontrolled in 19.9% of the subjects. High rates of uncontrolled asthma were found in subjects with treatment non-adherence (44.1%), concomitant allergic rhinitis (AR) (23.3%), disease duration ≥ 1.5 years (22.8%), and first-degree relatives with AR (21.5%). The risk of uncontrolled asthma was much higher in the treatment non-adherence group compared to the complete adherence group (OR = 5.79, p < 0.001). Concomitant AR, disease duration ≥ 1.5 years, and first-degree relatives with AR were also confirmed as risk factors associated with uncontrolled asthma. CONCLUSIONS About 20% of Chinese pediatric asthma patients had uncontrolled asthma. Treatment adherence and AR were the most significant risk factors. Tailored measures aimed at improving treatment adherence and diagnosis and treatment of AR should be adopted to improve the level of asthma control in Chinese children.
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Affiliation(s)
- Li Xiang
- a Department of Respiratory Disease , Beijing Children's Hospital, Capital Medical University , Beijing , China
| | - Jing Zhao
- b Department of Respiratory Disease , Children's Hospital Affiliated with Capital Institute of Pediatrics , Beijing , China
| | - Yuejie Zheng
- c Department of Respiratory Disease , Shenzhen Children's Hospital , Shenzhen , China
| | - Hanmin Liu
- d Department of Respiratory Disease , West China Second University Hospital , Chengdu , China
| | - Jianguo Hong
- e Department of Pediatrics , Shanghai General Hospital , Shanghai , China
| | - Yixiao Bao
- f Department of Pediatrics Respiratory Disease , Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Aihuan Chen
- g Department of Respiratory Disease , The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Li Deng
- h Department of Respiratory Disease , Guangzhou Women and Children's Medical Center , Guangzhou , China
| | - Wei Ji
- i Department of Respiratory Disease , Children's Hospital of Soochow University , Suzhou , China
| | - Nanshan Zhong
- j Guangzhou Institute of Respiratory Disease , Guangzhou , China
| | - Kunling Shen
- a Department of Respiratory Disease , Beijing Children's Hospital, Capital Medical University , Beijing , China
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14
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Effect of once-daily generic ciclesonide on exhaled nitric oxide in atopic children with persistent asthma. Allergol Immunopathol (Madr) 2016; 44:106-12. [PMID: 26001339 DOI: 10.1016/j.aller.2015.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/31/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Ciclesonide (CIC) is an effective inhaled corticosteroid for treating asthmatic children. However, its effect on airway inflammation assessed by the fraction of exhaled nitric oxide (FENO) in children with persistent asthma is virtually unknown. We aimed to assess the effect of once-daily generic CIC, 80 or 160 μg, on FENO, lung function, asthma control and bronchial hyperresponsiveness, in atopic children with persistent asthma. METHODS This was a 12-week, randomised, double-blind, parallel-group study. Sixty children with mild-to-moderate persistent asthma were recruited. Changes in FENO, asthma control score, lung function (FEV1) and bronchial hyperresponsiveness to methacholine (BHR) were used to assess the effects of both CIC doses. Non-normally distributed variables were log-transformed to approximate normality, and parametric tests were used for comparisons within and between groups at baseline and after 12 weeks of treatment. RESULTS In the CIC 80 μg group, FENO decreased from 45.0 ppb (95% CI 37.8-53.7) to 32.7 ppb (95% CI 21.0-47.3) at the end of study (P=0.021), whereas in the CIC 160 μg group, FENO decreased from 47.3 ppb (95% CI 40.4-55.3) to 30.5 ppb (95% CI 24.1-38.7) (P<0.001). The difference between groups in FENO at the end of study was not significant (P=0.693). There was a significant improvement of asthma control with both CIC doses but there was no significant change in BHR or FEV1 in either group. CONCLUSION Once-daily generic ciclesonide (80 μg or 160 μg), for 12 weeks, is effective to improve airway inflammation and asthma control in atopic children with persistent asthma.
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Voorend-van Bergen S, Vaessen-Verberne AA, de Jongste JC, Pijnenburg MW. Asthma control questionnaires in the management of asthma in children: A review. Pediatr Pulmonol 2015; 50:202-8. [PMID: 25187271 DOI: 10.1002/ppul.23098] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/01/2014] [Accepted: 06/03/2014] [Indexed: 11/06/2022]
Abstract
Several self-administered questionnaires have been developed to assess childhood asthma control in a simple and standardized way. This review discusses the most commonly used questionnaires and explores their usefulness in asthma management in children. We conclude that the use of asthma control questionnaires in daily practice and in research contributes to the standardized evaluation of children with asthma and helps to track asthma symptoms, but validation studies in a wider range of settings are needed.
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Affiliation(s)
- S Voorend-van Bergen
- Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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16
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Shefer G, Donchin M, Manor O, Levy-Hevroni R, Schechter A, Cohen R, Cohen HA, Kerem E, Engelhard D. Disparities in assessments of asthma control between children, parents, and physicians. Pediatr Pulmonol 2014; 49:943-51. [PMID: 24166798 DOI: 10.1002/ppul.22924] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/15/2013] [Accepted: 09/16/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Assessment of asthma control in children by physicians, patients and their parents was compared, assuming parents may underestimate symptoms in asthmatic children and exploring whether physicians tend to agree with them. DESIGN Asthma control perception was assessed in 4- to 11-year-old asthmatic children and their parents, using C-ACT, during 2011-2012. Pediatric pulmonologists used GINA guidelines for their assessment; pediatricians, not having spirometry, used the information given in addition to physical examination. The C-ACT scores given by the children and their parents were further analyzed separately, and compared with their physicians' assessment. Statistical methods, which also measured possible influence of different variables, included kappa, Chi-square, linear-by-linear association, McNemar test and logistic regression. PATIENT SELECTION The study comprised 354 parents and children aged 4-11 years with moderate-severe asthma; 129 (36.4%) were treated by 23 pediatricians; 225 (63.6%) by 11 pediatric pulmonologists. RESULTS The C-ACT was generally found valid in assessing asthma control (P < 0.001; κ 0.529; CI 0.441, 0.617) and showed that in 229/354 (53%) of children the asthma was uncontrolled. Nevertheless, of the 229 children who indicated their asthma was uncontrolled, 124 (54.1%) of their parents (κ 0.245; CI 0.15, 0.34) and 96 (41.9%) of their physicians believed it to be controlled (κ 0.331; 0.24, 0.43). Comparing the physician-child discordance vis-à-vis the parents, the significant difference was when 96/229 children (41.9%) and 34/126 parents (27.0%) indicated the asthma was uncontrolled while the physician determined it controlled (OR 1.95; 1.19, 3.24). There were no significant differences between pediatric pulmonologists and pediatricians. CONCLUSIONS In addition to increasing awareness of parents to symptoms in their asthmatic children, physicians should question the child appropriately, as well as using the children's responses to C-ACT as an information source for properly assessing asthma control.
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Affiliation(s)
- Galit Shefer
- Braun School of Public Health and Community Medicine, Hebrew University-Haddassah, Jerusalem, Israel
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17
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Deschildre A, Pin I, El Abd K, Belmin-Larrar S, El Mourad S, Thumerelle C, Le Roux P, Langlois C, de Blic J. Asthma control assessment in a pediatric population: comparison between GINA/NAEPP guidelines, Childhood Asthma Control Test (C-ACT), and physician's rating. Allergy 2014; 69:784-90. [PMID: 24725204 DOI: 10.1111/all.12402] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Guidelines recommend regular assessment of asthma control. The Childhood Asthma Control Test (C-ACT) is a clinically validated tool. AIM To evaluate asthma control according to GINA2006, NAEPP, pediatrician's assessment (PA), and C-ACT in asthmatic children visiting their ambulatory pediatrician or tertiary care pediatric pulmonologist. METHODS Demographic data, treatment, and number of severe exacerbations during the previous year were collected. Control was assessed using (i) strict GINA 2006 criteria, (ii) GINA without taking into account the exacerbation item, (iii) NAEPP criteria, and (iv) PA. Children and parents filled out the C-ACT. RESULTS Five hundred and twenty-five children completed the survey (mean age: 7.7 years; 28% ≤ 6 years). 78% had a controller treatment. 58% reported ≥ 1 severe exacerbation. C-ACT was ≤ 19 in 29.5%. Control was not achieved in 76.5%, 55%, 40%, and 34% according to GINA 2006 guidelines, NAEPP guidelines, GINA 2006 without exacerbation criteria, and PA, respectively. C-ACT was significantly lower in children ≤ 6 years old (P = 0.002) or with severe exacerbations (P < 0.0001). According to PA, 89% of patients with a C-ACT > 21 were controlled and 85% of patients with a C-ACT < 17 not controlled. CONCLUSION We observed discrepancies between the different tools applied to assess asthma control in children, and the impact of age and exacerbations. Cutoff point of 19 of C-ACT was not associated with the best performance compared to PA. Assessment of control should take into account symptoms and lung function as suggested by the latest GINA guidelines as well as exacerbation over a long period.
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Affiliation(s)
- A. Deschildre
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
| | - I. Pin
- Pédiatrie, Pôle Couple Enfants, CHU de Grenoble; INSERM U823; Institut Albert Bonniot; Université Joseph Fourier; Grenoble France
| | - K. El Abd
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
- Pédiatrie; CHC Espérance - Montegnée; Liège Belgium
| | - S. Belmin-Larrar
- Service de pneumologie et allergologie pédiatriques, AP-HP; Hôpital Necker Enfants Malades; Paris France
| | - S. El Mourad
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
| | - C. Thumerelle
- Unité de pneumologie-allergologie pédiatrique, pôle enfant, clinique de pédiatrie Jeanne de Flandre; CHRU de Lille; Université Nord de France; Lille France
| | - P. Le Roux
- Pédiatrie, groupe hospitalier du Havre; Le Havre France
| | - C. Langlois
- Département de biostatistiques, CHRU de Lille; Université Nord de France; Lille France
| | - J. de Blic
- Service de pneumologie et allergologie pédiatriques, AP-HP; Hôpital Necker Enfants Malades; Paris France
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18
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Nittner-Marszalska M, Liebhart J, Pawłowicz R, Kazimierczak A, Marszalska H, Kraus-Filarska M, Panaszek B, Dor-Wojnarowska A. Fractioned exhaled nitric oxide (FE(NO)) is not a sufficiently reliable test for monitoring asthma in pregnancy. Nitric Oxide 2013; 33:56-63. [PMID: 23756211 DOI: 10.1016/j.niox.2013.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 05/26/2013] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Abstract
It has been reported that fractioned exhaled nitric oxide (FENO) can be used for monitoring airway inflammation and for asthma management but conclusions drawn by different researchers are controversial. The aim of our study was to evaluate the clinical usefulness of FENO assessment for monitoring asthma during pregnancy. We monitored 72 pregnant asthmatics aged 18-38years (Me=29 years) who underwent monthly investigations including: the level of asthma control according to GINA (Global Initiative for Asthma), the occurrence of exacerbations, ACT (Asthma Control Test), as well as FENO and spirometry measurements. In 50 women, during all visits, asthma was well-controlled. In the remaining 22 women, asthma was periodically uncontrolled. FENO measured at the beginning of the study did not show significant correlation with retrospectively evaluated asthma severity (r=0.07; p=0.97). An analysis of data collected during all 254 visits showed that FENO correlated significantly but weakly with ACT scores (r=0.25; p=0.0004) and FEV1 (r=0.21; p=0.0014). FENO at consecutive visits in women with well-controlled asthma (N=50) showed large variability expressed by median coefficient of variation (CV)=32.0% (Min 2.4%, Max 121.9%). This concerned both: atopic and nonatopic groups (35.5%; and 26.7%, respectively). Large FENO variability (35.5%) was also found in a subgroup of women (N=11) with ACT=25 constantly throughout the study. FENO measured at visits when women temporarily lost control of asthma (N=22; 38 visits), showed an increasing tendency (64.2 ppb; 9.5 ppb-188.3 ppb), but did not differ significantly (p=0.13) from measurements taken at visits during which asthma was well-controlled (27.6 ppb; 6.2 ppb-103.4 ppb). The comparison of FENO in consecutive months of pregnancy in women who had well-controlled asthma did not show significant differences in FENO values during the time of observation. The assessment of asthma during pregnancy by means of monitoring FENO is of limited practical value due to this parameter's considerable intrasubject variability, regardless of the degree of asthma control.
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Affiliation(s)
- Marita Nittner-Marszalska
- Departament of Internal Diseases, Geriatrics and Allergology Medical University Wrocław, 50-367 Wrocław, Ul. Pasteura 4, Poland
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19
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Green RJ, Klein M, Becker P, Halkas A, Lewis H, Kitchin O, Moodley T, Masekela R. Disagreement among common measures of asthma control in children. Chest 2013; 143:117-122. [PMID: 22878380 DOI: 10.1378/chest.12-1070] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Asthma is a worldwide problem. It cannot be prevented or cured, but it is possible, at least in principle, to control asthma with modern management. Control usually is assessed by history of symptoms, physical examination, and measurement of lung function. A practical problem is that these measures of control may not be in agreement. The aim of this study was to describe agreement among different measures of asthma control in children. METHODS A prospective sequential sample of children aged 4 to 11 years with atopic asthma attending a routine follow-up evaluation were studied. Patients were assessed with the following four steps: (1) fraction of exhaled nitric oxide (FENO), (2) spirometry, (3) Childhood Asthma Control Test (cACT), and (4) conventional clinical assessment by a pediatrician. The outcome for each test was coded as controlled or uncontrolled asthma. Agreement among measures was examined by cross-tabulation and κ statistics. RESULTS Eighty children were enrolled, and nine were excluded. Mean FENO in pediatrician-judged uncontrolled asthma was double that of controlled asthma (37 parts per billion vs 15 parts per billion, P < .005). There was disagreement among measures of control. Spirometric indices revealed some correlation, but of the unrelated comparisons, those that agreed with each other most often (69%) were clinical assessment by the pediatrician and the cACT. Worst agreement was noted for FENO and cACT (49.3%). CONCLUSION Overall, different measures to assess control of asthma showed a lack of agreement for all comparisons in this study.
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Affiliation(s)
- Robin J Green
- Division of Pulmonology, Department of Paediatrics and Child Health, University of Pretoria, Pretoria.
| | - Max Klein
- Division of Pulmonology, Department of Paediatrics and Child Health, University of Pretoria, Pretoria
| | - Piet Becker
- Biostatistics Unit, South African Medical Research Council, Pretoria
| | - Andrew Halkas
- Paediatricians in Private Practice, Gauteng, South Africa
| | - Humphrey Lewis
- Paediatricians in Private Practice, Gauteng, South Africa
| | - Omolemo Kitchin
- Division of Pulmonology, Department of Paediatrics and Child Health, University of Pretoria, Pretoria
| | - Teshni Moodley
- Division of Pulmonology, Department of Paediatrics and Child Health, University of Pretoria, Pretoria
| | - Refiloe Masekela
- Division of Pulmonology, Department of Paediatrics and Child Health, University of Pretoria, Pretoria
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20
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Shi Y, Tatavoosian AV, Aledia AS, George SC, Galant SP. Cut points for Asthma Control Tests in Mexican children in Orange County, California. Ann Allergy Asthma Immunol 2012; 109:108-13. [PMID: 22840251 DOI: 10.1016/j.anai.2012.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/07/2012] [Accepted: 06/01/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Childhood Asthma Control Test (C-ACT) and the Asthma Control Test (ACT) are validated measures of asthma control in which a score of 19 is defined as uncontrolled according to published reports. However, different cut points may exist in different ethnic populations. OBJECTIVE To determine the cut point for uncontrolled asthma in a Mexican descent population from Orange Country, California, compared with an age- and asthma severity-matched non-Hispanic cohort. METHODS The C-ACT (in children 6-11 years old) and ACT (in children 12-17 years old) scores were collected from 151 children of Mexican descent and 48 non-Hispanic controls with mild-to-moderate asthma who lived in Orange County. Physicians were masked to C-ACT and ACT scores while assessing control based on National Asthma Education and Prevention program guidelines. The receiver operating characteristic method was used to examine the screening accuracy of the tests to detect uncontrolled asthma. The optimal cut points were selected by maximizing the total sensitivity and specificity. RESULTS Cronbach α values for the C-ACT (0.76) and the ACT (0.80) confirmed that both tests were reliable in our study population. The C-ACT and ACT scores were statistically higher in children of Mexican descent than non-Hispanic children (P = .008). A cut point of 22 was optimal to detect uncontrolled asthma in children of Mexican descent 6 to 11 years old (group 1: sensitivity, 0.74; specificity, 0.86; area under the curve [AUC], 0.83) and children 12 to 17 years old (group 3: sensitivity, 0.78; specificity, 0.68; AUC, 0.79). For non-Hispanic controls, a cut point of 20 were optimal to detect uncontrolled asthma in children 6 to 11 years old (group 2: sensitivity, 0.70; specificity, 0.91; AUC, 0.86) and children 12 to 17 years old (group 4: sensitivity, 0.83; specificity, 0.87; AUC, 0.91). CONCLUSION In this cross-ethnic validation study, children of Mexican descent in Orange County seem to underreport asthma symptoms compared with a non-Hispanic population and may require higher C-ACT and ACT cut points to detect uncontrolled asthma.
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Affiliation(s)
- Yixin Shi
- Department of Biomedical Engineering, University of California, Irvine, California, USA
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Ko FWS, Hui DSC, Leung TF, Chu HY, Wong GWK, Tung AHM, Ngai JCN, Ng SSS, Lai CKW. Evaluation of the asthma control test: a reliable determinant of disease stability and a predictor of future exacerbations. Respirology 2012; 17:370-8. [PMID: 22107482 DOI: 10.1111/j.1440-1843.2011.02105.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE This study assessed the asthma control test (ACT) cut-off values for asthma control according to the Global Initiative for Asthma guideline in adults and the effectiveness of ACT scores in predicting exacerbations and serial changes in ACT scores over time in relation to treatment decisions. METHODS Subjects completed ACT together with same-day spirometry and fractional concentration of exhaled nitric oxide (FeNO) measurement at baseline and at 3 months. Physicians, blinded to the ACT scores and FeNO values, assessed the patient's asthma control in the past month and adjusted the asthma medications according to management guidelines. Asthma exacerbations and urgent health-care utilization (HCU) at 6 months were recorded. RESULTS Three hundred seventy-nine (120 men) asthmatics completed the study. The ACT cut-off for uncontrolled and partly controlled asthma were ≤19 (sensitivity 0.74, specificity 0.67, % correctly classified 69.5) and ≤22, respectively (sensitivity 0.73, specificity 0.71, % correctly classified 72.1). Baseline ACT score had an odds ratio of 2.34 (95% confidence interval: 1.48-3.69) and 2.66 (1.70-4.18) for urgent HCU and exacerbations, respectively, at 6 months (P < 0.0001). However, baseline FeNO and spirometry values had no association with urgent HCU and exacerbations. The 3-month ACT score of ≤20 correlated best with step-up of asthma medications (sensitivity 0.65, specificity 0.81, % correctly classified 72.8). For serial changes of ACT scores over 3 months, the cut-off value was best at ≤3 for treatment decisions with low sensitivity (0.23) and % correctly classified (57.3%) values. CONCLUSIONS Single measurement of ACT is useful for assessing asthma control, prediction of exacerbation and changes in treatment decisions.
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Affiliation(s)
- Fanny W S Ko
- Departments of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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Yavuz ST, Civelek E, Sahiner UM, Buyuktiryaki AB, Tuncer A, Karabulut E, Sekerel BE. Identifying uncontrolled asthma in children with the childhood asthma control test or exhaled nitric oxide measurement. Ann Allergy Asthma Immunol 2012; 109:36-40. [PMID: 22727155 DOI: 10.1016/j.anai.2012.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/28/2012] [Accepted: 05/07/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND International guidelines highlight the importance of assessing asthma control status in children with asthma, and research on practical and objective instruments for assessing asthma control is ongoing. OBJECTIVE To determine the role of the Childhood Asthma Control Test (C-ACT) and fractional concentration of exhaled nitric oxide (FeNO) in identifying children with not well-controlled asthma. METHODS Children 6 to 11 years of age with asthma were enrolled in the study. They completed C-ACT and underwent FeNO and spirometric measurements during the monthly clinic visits. An asthma specialist assessed asthma control according to the gold standard Global Initiative for Asthma guideline and decided the treatment of the patients. RESULTS Seventy-six children with a mean (SD) age of 8.7 (1.4) years were evaluated in the first visit, whereas 64 and 51 children were admitted for second and third visits, respectively. A C-ACT score of 22 or less had 69% sensitivity and 77% specificity in determining not well-controlled asthma, whereas an FeNO value of 19 ppb or higher had 61% sensitivity and 59% specificity in patients who completed 3 visits. Receiver operating characteristic curve analysis revealed that the C-ACT was better than FeNO for identifying patients with not well-controlled asthma (area under the curve, 0.79; P < .001 [C-ACT] vs .58, P = .10 [FeNO]) Results of multivariate generalized estimating equation analysis revealed that a C-ACT score of 22 or less (odds ratio, 8.75; 95% confidence interval, 4.35-17.59; P < .001) and an FeNO of 19 ppb or greater (odds ratio, 2.60; 95% confidence interval, 1.07-6.29; P = .03) were significant indicators for the presence of not well-controlled asthma. CONCLUSION The C-ACT is superior to FeNO in determining the control status of children with asthma and may be used as a complementary tool in clinical practice to detect children with not well-controlled asthma.
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Affiliation(s)
- Suleyman Tolga Yavuz
- Faculty of Medicine, Pediatric Allergy and Asthma Unit, Hacettepe University, Ankara, Turkey
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Cloutier MM, Schatz M, Castro M, Clark N, Kelly HW, Mangione-Smith R, Sheller J, Sorkness C, Stoloff S, Gergen P. Asthma outcomes: composite scores of asthma control. J Allergy Clin Immunol 2012; 129:S24-33. [PMID: 22386507 DOI: 10.1016/j.jaci.2011.12.980] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 12/23/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Current asthma guidelines recommend assessing the level of a patient's asthma control. Consequently, there is increasing use of asthma control as an outcome measure in clinical research studies. Several composite assessment instruments have been developed to measure asthma control. OBJECTIVE National Institutes of Health institutes and federal agencies convened an expert group to propose the most appropriate standardized composite score of asthma control instruments to be used in future asthma studies. METHODS We conducted a comprehensive search of PubMed using both the National Library of Medicine's Medical Subject Headings and key terms to identify studies that attempted to develop and/or test composite score instruments for asthma control. We classified instruments as core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at a National Institutes of Health-organized workshop convened in March 2010 and finalized in September 2011. RESULTS We identified 17 composite score instruments with published validation information; all had comparable content. Eight instruments demonstrated responsiveness over time; 3 demonstrated responsiveness to treatment. A minimal clinically important difference has been established for 3 instruments. The instruments have demographic limitations; some are proprietary, and their use could be limited by cost. CONCLUSION Two asthma composite score instruments are sufficiently validated for use in adult populations, but additional research is necessary to validate their use in nonwhite populations. Gaps also exist in validating instruments for pediatric populations.
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Waibel V, Ulmer H, Horak E. Assessing asthma control: symptom scores, GINA levels of asthma control, lung function, and exhaled nitric oxide. Pediatr Pulmonol 2012; 47:113-8. [PMID: 22241569 DOI: 10.1002/ppul.21529] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 05/25/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND The childhood asthma control test (C-ACT) is a validated symptom score for assessing asthma control in children. We used a slightly modified version (C-ACT(M) ) of the German C-ACT and compared our results with the literature, correlated the children's part of C-ACT (C-ACT(children) ) with a visual analogue scale (VAS(children) ), explored the agreement between C-ACT(M) and GINA levels of asthma control, as well as the relationship between C-ACT(M) and lung function and exhaled nitric oxide (FeNO). METHODS We investigated 107 children with a diagnosis of asthma. The study protocol consisted of a clinical examination, assessment of asthma control according to GINA guidelines, administration of C-ACT(M) , VAS(children) , lung function, and FeNO. RESULTS Of our patients 66% had, according to GINA, partly controlled-/uncontrolled asthma, 18% were uncontrolled according to C-ACT(M) . Children with partly controlled-/uncontrolled asthma according to GINA had lower C-ACT(M) scores than did children with controlled asthma (16.1 ± 3.6 SD vs. 25.4 ± 1.8 SD; P < 0.000), and children with a C-ACT(M) score ≤ 19 had poorer lung function (mean FEV1% predicted 81.5 ± 13.5 SD vs. 94.2 ± 12.1 SD; P = 0.002). Spearman's rank correlation coefficients revealed significant correlations between all symptom scores. Multiple linear regression adjusted for age, gender, FEV1 and FeNO demonstrated a significant relationship between C-ACT(M) , VAS(children) , and FEV1 (P = 0.003, resp. <0.000), but no significant correlation between C-ACT(M) , VAS(children) , and FeNO. CONCLUSIONS The German version of C-ACT(M) is valid and useful for monitoring children with asthma along with tests aimed to follow up lung function and airway inflammation. Concordance between C-ACT(M) and GINA is moderate, because asthma control assessed by C-ACT(M) allows more symptoms and lung function is not included in the scoring.
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Affiliation(s)
- Vanessa Waibel
- University Hospital for Children and Adolescents, Innsbruck Medical University, Innsbruck, Austria.
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