Allergy Asthma Respir Dis.  2015 Jul;3(4):261-266. 10.4168/aard.2015.3.4.261.

Utility of tools for the assessment of asthma control in childhood asthma

• Kim HS
• Kim YH
• Lee HS
• Han YK
• Park YA
• Kim KW
• Sohn MH
• Kim KE

• KMID: 2218655
• DOI: http://doi.org/10.4168/aard.2015.3.4.261

Abstract

PURPOSE
The goal of asthma control is to maintain well-controlled state. In this study, we investigated whether childhood asthma control test (C-ACT) may reflect lung function and whether fractional exhaled nitric oxide (FeNO) can be used to improve the accuracy of C-ACT in reflecting the asthma control level.
METHODS
We reviewed the medical records of 155 patients with asthma underwent lung function tests and C-ACT upon visiting our outpatient clinic. We compared lung function test results according to the C-ACT score stratified by atopy and also examined FeNO according to C-ACT and the Global Initiative for Asthma (GINA) guidelines. The diagnostic accuracy of well-controlled asthma by C-ACT, FeNO, and C-ACT+FeNO was examined. We also calculated the cutoff value of FeNO and C-ACT for well-controlled asthma.
RESULTS
Peak expiratory flow (PEF) showed a significant correlation with the C-ACT score. Stratified by atopy, PEF, and forced expiration in one second (FEV1) showed significant correlations with the C-ACT score in the atopic asthma group. There was no difference in FeNO between subjects with C-ACT> or =20 and <20, but FeNO was significantly higher in the uncontrolled asthma according to the GINA guidelines. The diagnostic accuracy of well-controlled asthma was higher when FeNO was combined with the C-ACT score than C-ACT or FeNO. Our study showed that the cutoff values of C-ACT and FeNO 19 and 18.3 ppb (parts per billion), respectively, for well-controlled asthma.
CONCLUSION
C-ACT showed a significant correlation with PEF, and atopic asthma group showed significant correlations with PEF and FEV1. A combination of C-ACT with FeNO might reflect asthma control status more accurately.

Keyword

Asthma; Questionnaire; Child; Pulmonary function test; Nitric oxide

MeSH Terms

Ambulatory Care Facilities
Asthma*
Child
Humans
Lung
Medical Records
Nitric Oxide
Respiratory Function Tests
Nitric Oxide

Figure

• 

  Fig. 1 Fractional nitric oxide (FeNO) of controlled vs. uncontrolled asthma by childhood asthma control test (C-ACT; A) and global initiative for asthma (GINA; B). ppb, parts per billion.

• 

  Fig. 2 Receiver operating characteristic (ROC) curve of the childhood asthma control test (C-ACT) score, fractional nitric oxide (FeNO), and C-ACT-FeNO for identifying well controlled asthmatic children according to GINA (global initiative for asthma) guideline.

Reference

1. The Global Initiative for Asthma. GINA report, global strategy for asthma management and prevention. Revised 2014 [Internet]. The Global Initiative for Asthma;c2014. cited 2014 Sep 26. Available from: http://www.ginasthma.org/local/uploads/files/GINA_Report_2014_Jun11.pdf.

2. Expert Panel Report 3: guidelines for the diagnosis and management of asthma. Full report 2007. National Asthma Education and Prevention Program [Internet]. Bethesda (MD): National Heart, Lung, and Blood Institute (US);2007. cited 2014 Mar 12. Available from: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.

3. Payne DN, Adcock IM, Wilson NM, Oates T, Scallan M, Bush A. Relationship between exhaled nitric oxide and mucosal eosinophilic inflammation in children with difficult asthma, after treatment with oral prednisolone. Am J Respir Crit Care Med. 2001; 164(8 Pt 1):1376–1381.

4. Kharitonov SA, Gonio F, Kelly C, Meah S, Barnes PJ. Reproducibility of exhaled nitric oxide measurements in healthy and asthmatic adults and children. Eur Respir J. 2003; 21:433–438.

5. Green RH, Brightling CE, McKenna S, Hargadon B, Parker D, Bradding P, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet. 2002; 360:1715–1721.

6. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004; 113:59–65.

7. Juniper EF, O'Byrne PM, Guyatt GH, Ferrie PJ, King DR. Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999; 14:902–907.

8. Murphy KR, Zeiger RS, Kosinski M, Chipps B, Mellon M, Schatz M, et al. Test for respiratory and asthma control in kids (TRACK): a caregiver-completed questionnaire for preschool-aged children. J Allergy Clin Immunol. 2009; 123:833–839.e9.

9. LeBlanc A, Robichaud P, Lacasse Y, Boulet LP. Quantification of asthma control: validation of the Asthma Control Scoring System. Allergy. 2007; 62:120–125.

10. Schatz M, Sorkness CA, Li JT, Marcus P, Murray JJ, Nathan RA, et al. Asthma control test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol. 2006; 117:549–556.

11. Liu AH, Zeiger R, Sorkness C, Mahr T, Ostrom N, Burgess S, et al. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol. 2007; 119:817–825.

12. Yu HR, Niu CK, Kuo HC, Tsui KY, Wu CC, Ko CH, et al. Comparison of the Global Initiative for Asthma guideline-based Asthma Control Measure and the Childhood Asthma Control Test in evaluating asthma control in children. Pediatr Neonatol. 2010; 51:273–278.

13. Papakosta D, Latsios D, Manika K, Porpodis K, Kontakioti E, Gioulekas D. Asthma control test is correlated to FEV1 and nitric oxide in Greek asthmatic patients: influence of treatment. J Asthma. 2011; 48:901–906.

14. Kim JO, Woo SI, Hahn YS. Relevance of exhaled nitric oxide levels to asthma control test scores and spirometry values in children with atopic asthma. Pediatr Allergy Respir Dis. 2011; 21:24–31.

15. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005; 26:319–338.

16. Song DJ, Han YN, Lee JH, Kim HJ, Lim JY, Pee DH, et al. Lung function reference values in healthy Korean children. Pediatr Allergy Respir Dis. 2002; 12:105–113.

17. Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000; 161:309–329.

18. American Thoracic Society. European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med. 2005; 171:912–930.

19. Pijnenburg MW, De Jongste JC. Exhaled nitric oxide in childhood asthma: a review. Clin Exp Allergy. 2008; 38:246–259.

20. Khalili B, Boggs PB, Shi R, Bahna SL. Discrepancy between clinical asthma control assessment tools and fractional exhaled nitric oxide. Ann Allergy Asthma Immunol. 2008; 101:124–129.

21. Shirai T, Furuhashi K, Suda T, Chida K. Relationship of the asthma control test with pulmonary function and exhaled nitric oxide. Ann Allergy Asthma Immunol. 2008; 101:608–613.

22. Senna G, Passalacqua G, Schiappoli M, Lombardi C, Wilcock L. Correlation among FEV, nitric oxide and asthma control test in newly diagnosed asthma. Allergy. 2007; 62:207–208.

23. Yavuz ST, Civelek E, Sahiner UM, Buyuktiryaki AB, Tuncer A, Karabulut E, et al. Identifying uncontrolled asthma in children with the childhood asthma control test or exhaled nitric oxide measurement. Ann Allergy Asthma Immunol. 2012; 109:36–40.

24. Ito Y, Adachi Y, Itazawa T, Okabe Y, Adachi YS, Higuchi O, et al. Association between the results of the childhood asthma control test and objective parameters in asthmatic children. J Asthma. 2011; 48:1076–1080.

25. Melosini L, Dente FL, Bacci E, Bartoli ML, Cianchetti S, Costa F, et al. Asthma control test (ACT): comparison with clinical, functional, and biological markers of asthma control. J Asthma. 2012; 49:317–323.