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TRACK as a complementary tool to GINA and NAEPP guidelines for assessing asthma control in pre-school children
Ayşenur Kaya1, Mustafa Erkocoglu, Aysegul Akan
1Ankara Children's Hematology Oncology Education and Research Hospital, Pediatric Allergy Department , Altındağ, Ankara , Turkey.
Insights
The TRACK questionnaire shows good consistency with GINA and NAEPP asthma guidelines for children under 5. However, clinical evaluation remains crucial for accurate asthma control assessment and management.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Clinical Trial Methodology
Background:
- Assessing asthma control in young children (<5 years) is challenging.
- Consistency between patient-reported outcomes and clinical guidelines is essential for effective management.
- The TRACK questionnaire's utility in this age group requires evaluation against established guidelines.
Purpose of the Study:
- To evaluate the consistency of the TRACK questionnaire with asthma control levels defined by the Global Initiative for Asthma (GINA) and the National Asthma Education and Prevention Program (NAEPP) guidelines.
- To determine the optimal cut-off point for the TRACK questionnaire for reliable asthma control assessment in children under 5.
- To identify potential discrepancies between the TRACK questionnaire and guideline-based assessments.
Main Methods:
- A prospective study involving children under 5 with recurrent wheezing followed for at least 1 year.
- Parents completed the TRACK questionnaire; asthma control was assessed by a pediatric allergist blinded to TRACK scores, according to GINA and NAEPP guidelines.
- Patients were categorized based on the agreement between TRACK scores and guideline-based control levels.
Main Results:
- A total of 365 questionnaires were analyzed.
- A TRACK cut-off score of 80 demonstrated the best balance of sensitivity and specificity for concordance with both GINA (kappa=0.487) and NAEPP (kappa=0.524) guidelines.
- Using a cut-off of 80, the compatibility rates between TRACK and GINA/NAEPP were 71.0% and 76.4%, respectively.
- Significant differences were observed in GINA-based asthma control classifications for patients with TRACK scores >80, particularly in mild (70.1% controlled) versus moderate-to-severe asthma (50.0% uncontrolled).
Conclusions:
- The TRACK questionnaire demonstrates substantial compatibility with both GINA and NAEPP guidelines for assessing asthma control in children under 5.
- Despite good overall agreement, discrepancies exist, highlighting the need for integrating TRACK scores with comprehensive clinical examinations.
- A combined approach using the TRACK questionnaire and clinical judgment is recommended for precise asthma control assessment and tailored management plans in young children.
Background:
In this study, our goal is to evaluate the consistency between TRACK and the asthma control levels assessed according to the GINA and NAEPP guidelines in children younger than 5 years of age.
Methods:
Patients under 5 years old, who were followed up for recurrent wheezing for at least 1 year have been included. Parents were given the TRACK questionnaire and the control level of asthma according to GINA and NAEPP guidelines were determined by a pediatric allergist blinded to TRACK scores. Patients were classified into two groups regarding the compatibility of the control level between TRACK and both GINA and NAEPP guidelines.
Results:
A total of 365 questionnaires were evaluated. The TRACK cut-off point of 80 provided the most consistent balance between sensitivity and specificity for the compatibility with both GINA and NAEPP (for GINA 0.763 and 0.663, kappa = 0.487, p < 0.001 and for NAEPP 0.761 and 0.769, kappa = 0.524, p < 0.001, respectively). When 80 was taken as the cut-off value for TRACK, the compatibility rate of asthma control levels between TRACK and GINA and TRACK and NAEPP was 71.0 and 76.4%, respectively. About 70.1% of the patients who had TRACK scores over 80 and had mild asthma were grouped as controlled according to GINA and 50.0% of patients who had TRACK scores over 80 and had moderate to severe asthma was grouped as uncontrolled according to GINA (p = 0.019).
Conclusion:
TRACK is compatible with NAEPP and GINA in majority of asthmatic children under 5 years of age. Nevertheless, there is a discrepancy between guidelines and TRACK scores; therefore, it should be used in conjunction with a detailed clinical examination in order to make a better decision for assessing the control levels and management plan.
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