The Visual Analog Scale detects exercise-induced bronchoconstriction in children with asthma

Area of Science:

• Pediatric Pulmonology
• Asthma Research
• Diagnostic Tools in Respiratory Medicine

Background:

• Exercise-induced bronchoconstriction (EIB) is a common issue in childhood asthma, often indicating poor asthma control.
• Current asthma control tests, like the Childhood Asthma Control Test (C-ACT) and Asthma Control Test (ACT), may not sufficiently identify EIB.
• There is a need for improved diagnostic tools to detect EIB in pediatric asthma patients.

Purpose of the Study:

• To evaluate the Visual Analog Scale (VAS) for dyspnea as a tool for detecting EIB in children with asthma.
• To assess the combined diagnostic value of VAS scores and (C-)ACT outcomes for identifying EIB.
• To determine the effectiveness of VAS in identifying children with uncontrolled asthma and EIB.

Main Methods:

• Seventy-five asthmatic children underwent a standardized exercise challenge test (ECT) in cold, dry air to measure EIB.
• Children and their parents reported VAS dyspnea scores before and after the ECT.
• Asthma control was assessed using the (C-)ACT, and EIB was confirmed by changes in forced expiratory volume in 1 second (FEV1).

Main Results:

• Changes in VAS scores (ΔVAS) showed moderate correlation with the fall in FEV1 (rs=0.57 for children, rs=0.58 for parents).
• A ΔVAS cutoff of ≥3 in children demonstrated 80% sensitivity and 79% specificity for EIB (AUC 0.82).
• Combining a ΔVAS of ≥3 and/or a (C-)ACT score ≤19 identified 97% of children with EIB, with a 96% negative predictive value.

Conclusions:

• The VAS for dyspnea is a valuable supplementary tool for diagnosing EIB in pediatric asthma.
• A combination of a ΔVAS of ≥3 post-ECT and low (C-)ACT scores is highly effective for diagnosing and ruling out EIB in children.
• This combined approach enhances the identification of EIB, contributing to better asthma management in children.