Journal List > Allergy Asthma Respir Dis > v.3(4) > 1059110

Kim, Kim, Lee, Han, Park, Kim, Sohn, and Kim: Utility of tools for the assessment of asthma control in childhood asthma

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≥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.

Figures and Tables

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.

aard-3-261-g001
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.

aard-3-261-g002
Table 1

Characteristics of study population (n=155)

aard-3-261-i001
Characteristic Value
Age (yr) 7.7 ± 2.1
Male sex 103 (66.5)
Asthma severity
 Mild persistent asthma 135 (87.1)
 Moderate persistent asthma 2 (1.2)
 Severe persistent asthma 18 (11.6)
Atopy
 Atopic 111 (71.6)
 Nonatopic 26 (16.8)
 Undetermined 18 (11.6)
C-ACT ≥ 20 102 (65.8)
Well controlled with GINA 136 (87.7)
FEV1 (% predicted) > 80% 137 (88.4)
FeNO<25 ppb (n=21) 7 (33.3)

Values are presented as mean±standard deviation or number (%).

C-ACT, childhood asthma control test; GINA, global initiative for asthma; FEV1, forced expiration in one second; FeNO, fractional exhaled nitric oxide; ppb, parts per billion.

Table 2

Correlation between childhood asthma control test and pulmonary function test

aard-3-261-i002
FEV1 dFEV1 PEF FEV1/FVC FEF25%-75%
C-ACT 0.002 (0.102) 0.004 (0.465) 0.029 (0.035) 0.000 (0.876) 0.013 (0.159)

Value are presneted as r (P-value).

C-ACT, childhood asthma control test; FEV1, forced expiratory volume in one second; dFEV1, % change in FEV1; PEF, peak expiratory flow; FEF25%-75%, forced expiratory flow between 25%-75% of forced vital capacity.

Table 3

Correlation between childhood asthma control test and pulmonary function test in atopic asthma

aard-3-261-i003
FEV1 dFEV1 PEF FEV1/FVC FEF25%-75%
C-ACT 0.066 (0.013) 0.018 (0.196) 0.065 (0.014) 0.002 (0.646) 0.039 (0.060)

Value are presneted as r (P-value).

C-ACT, childhood asthma control test; FEV1, forced expiratory volume in one second; dFEV1, % change in FEV1; PEF, peak expiratory flow; FEF25%-75%, forced expiratory flow between 25%-75% of forced vital capacity.

Table 4

Sensitivity, specificity, positive predictive value, and negative predictive value of childhood asthma control test and fractional exhaled nitric oxide for identifying well controlled asthmatic children according to GINA guidelines

aard-3-261-i004
Parameter Cutoff-value Sensitivity (%) Specificity (%) PPV NPV
C-ACT 19.0 68.4 52.6 17.7 91.8
FeNO 18.3 82.4 25.0 36.0 98.8
C-ACT+FeNO 39.9 75.0 23.5 76.5 100

C-ACT, childhood asthma control test; FeNO, fractional exhaled nitric oxide; PPV, positive predictive value; NPV, negative predictive value; GINA, global initiative for asthma.

Notes

This study was funded by a grant from Kuhnil Pharmaceutical in 2012.

References

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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
TOOLS
ORCID iDs

Yoon Hee Kim
https://orcid.org/http://orcid.org/0000-0002-2149-8501

Similar articles