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The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity
D S Chalut1, F M Ducharme, G M Davis
1Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec,Canada.
Insights
A new tool, the Preschool Respiratory Assessment Measure (PRAM), accurately assesses acute asthma severity in young children. This validated measure helps track airway obstruction and treatment response in pediatric asthma patients.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Assessment Tools
Background:
- Asthma is a common chronic respiratory disease in children.
- Accurate assessment of asthma severity and treatment response in preschool-aged children is challenging.
- Existing tools may not be sufficiently sensitive or specific for this age group.
Purpose of the Study:
- To develop and validate the Preschool Respiratory Assessment Measure (PRAM).
- To create a tool that accurately reflects airway obstruction severity in young asthma patients.
- To evaluate PRAM's ability to monitor treatment response in pediatric asthma.
Main Methods:
- A prospective cohort study involving 217 children aged 3-6 years with acute asthma.
- Respiratory resistance measured by forced oscillation served as the gold standard.
- Children were randomized into test (PRAM development) and validation groups.
Main Results:
- The PRAM model included wheezing, air entry, scalene contraction, suprasternal retraction, and oxygen saturation.
- In the validation group, PRAM showed substantial correlation with change in resistance (r=0.58).
- A PRAM change of 3 indicated a clinically important change in asthma severity.
Conclusions:
- PRAM is a responsive tool for assessing acute asthma severity in preschool children.
- PRAM demonstrates moderate discriminative ability for pediatric asthma.
- The PRAM has been validated against lung function measures in young patients.
Objective:
To elaborate and validate a Preschool Respiratory Assessment Measure (PRAM) that would accurately reflect the severity of airway obstruction and the response to treatment in young patients with asthma.
Study Design:
A prospective cohort study was performed in 217 children aged 3 to 6 years who presented to a pediatric emergency department with acute asthma. Respiratory resistance measured by forced oscillation served as a gold standard. Children were randomized to either the test group, in which multivariate analyses were performed to elaborate the PRAM, or the validation group, in which the characteristics of the PRAM were tested.
Results:
For the test group (N = 145), the best multivariate model contained 5 variables: wheezing, air entry, contraction of scalenes, suprasternal retraction, and oxygen saturation. In the validation group (N = 72), the PRAM correlated substantially with the change in resistance (r = 0.58) but modestly with the % predicted resistance measured before (r = 0.22) and after bronchodilation (r = 0.36). A change of 3 (95% CI: 2.2, 3.0) indicated a clinically important change.
Conclusions:
PRAM appears to be a responsive but moderately discriminative tool for assessing acute asthma severity. This measure, designed for preschool-aged children, has been validated against a concurrent measure of lung function.
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