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Predicting changes in clinical status of young asthmatics: clinical scores or objective parameters?
Ting F Leung1, Fanny W S Ko, Gary W K Wong
1Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. tfleung@cuhk.edu.hk
Insights
The Childhood Asthma Control Test (C-ACT) effectively predicts asthma exacerbations in young children. This simple tool outperforms traditional methods in assessing disease control and indicating changes in asthma status.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Assessment
Background:
- Asthma exacerbations pose a significant challenge in pediatric asthma management.
- Current clinical tools exhibit limitations in predicting asthma exacerbations among young children.
- The Childhood Asthma Control Test (C-ACT) has emerged as a promising, simple assessment for pediatric asthma control.
Purpose of the Study:
- To evaluate the utility of the C-ACT and other disease-related factors in tracking longitudinal asthma status changes.
- To determine the predictive value of C-ACT for asthma exacerbations in children aged 4-11 years.
- To compare the effectiveness of C-ACT against traditional measures like Disease Severity Score (DSS) and objective parameters.
Main Methods:
- A cohort of 97 children (4-11 years) with asthma completed the Chinese version of C-ACT.
- Exhaled nitric oxide and spirometry (FEV1) were measured during clinic visits.
- Disease Severity Score (DSS) and Global Initiative for Asthma control ratings were assigned; exacerbations were recorded over 6 months.
Main Results:
- C-ACT, DSS, and FEV1 showed significant differences across asthma control statuses (P < 0.001 for C-ACT/DSS, P = 0.028 for FEV1).
- Changes in C-ACT scores correlated with changes in asthma control status, DSS, and FEV1 (P = 0.019-0.034).
- Lower baseline C-ACT scores were associated with subsequent asthma exacerbations (P = 0.015), confirmed by logistic regression (P = 0.042).
Conclusions:
- The C-ACT demonstrates superior ability compared to DSS and objective measures in reflecting asthma status changes in young children.
- Baseline C-ACT scores are a significant predictor of future asthma exacerbations in this pediatric population.
- C-ACT offers a valuable tool for improving asthma management and exacerbation prevention in children.
Abstract:
Preventing asthma exacerbation is an important goal of asthma management. The existing clinical tools are not good in predicting asthma exacerbations in young children. Childhood Asthma Control Test (C-ACT) was recently published to be a simple tool for assessing disease control in young children. This study investigated C-ACT and other disease-related factors for indicating longitudinal changes in asthma status and predicting asthma exacerbations. During the same clinic visit, asthma patients aged 4-11 years completed the Chinese version of C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma. Asthma exacerbations during the next 6 months were recorded. Ninety-seven patients were recruited, with their mean (standard deviation [SD]) age being 9.2 (2.0) years. Thirty-six (37.1%) patients had uncontrolled asthma at baseline. C-ACT, DSS, and FEV(1) differed among patients with different control status (P < 0.001 for C-ACT and DSS; P = 0.028 for FEV(1)). Thirty-two patients had asthma exacerbations during the 6-month follow-up. Changes in patients' C-ACT scores correlated with changes in asthma control status, DSS, and FEV(1) (P = 0.019, 0.034, and 0.020, respectively). C-ACT score was lower among patients with asthma exacerbations (mean [SD]: 22.9 [4.2] vs. 24.5 [2.1]; P = 0.015). Logistic regression confirmed that the occurrence of asthma exacerbations was associated only with baseline C-ACT (B = -0.203, P = 0.042). In conclusion, C-ACT is better than DSS and objective parameters in reflecting changes in asthma status and predicting asthma exacerbations in young children.
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