Asthma Control Test and Bronchial Challenge with Exercise in Pediatric Asthma

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Clinical Asthma Research

Background:

• Poorly controlled asthma frequently leads to exercise-induced bronchoconstriction (EIB).
• The correlation between subjective asthma control and EIB is not well-defined.
• No prior studies have compared children's and parents' Asthma Control Test (ACT) scores concerning EIB.

Purpose of the Study:

• To determine if ACT scores predict EIB in two distinct pediatric age groups.
• To evaluate ACT scores and objective measures as predictors of airway response to exercise.

Main Methods:

• Children (<12 and ≥12 years) and their parents completed separate ACT questionnaires.
• Assessed current therapy, skin prick testing, and spirometry (baseline and post-exercise).
• Defined EIB as ≥12% fall in forced expiratory volume in 1 second (FEV1); analyzed ACT score predictive values using receiver operating characteristic curves.

Main Results:

• EIB prevalence was 23.9% (<12 years) and 33.3% (≥12 years).
• In children ≥12 years, EIB occurrence increased as ACT scores decreased (child scores: p=0.017).
• ACT scores showed moderate predictive value for EIB in older children (child: AUC=0.67; parent: AUC=0.69), with high specificity but low sensitivity for scores <20.

Conclusions:

• ACT scores are more effective for excluding than confirming EIB in children ≥12 years.
• The predictive utility of ACT scores for EIB diminishes in younger children.
• Combining ACT scores with lung function may improve prediction of exercise-induced airway response in pediatric asthma.