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Determining the Best Tool Comparable with Global Initiative for Asthma Criteria for Assessing Pediatric Asthma
Ayşegül Akan1, Emine Dibek Mısırlıoğlu2, Ersoy Civelek2
1Department of Pediatric Allergy and Immunology, Trabzon Kanuni Research and Training Hospital, Health Sciences University, Trabzon, Turkey.
Insights
The Asthma Control Test (ACT) better aligns with Global Initiative for Asthma (GINA) guidelines for assessing childhood asthma control than the Pediatric Asthma Control Test (PACT) or Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Older children showed improved correlation with PAQLQ and ACT.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Clinical Assessment
Background:
- Global Initiative for Asthma (GINA) guidelines emphasize disease control as central to asthma management.
- Accurate assessment of asthma control is crucial for effective treatment adjustments in children.
- Various tools exist to measure asthma control, but their correlation with established guidelines needs clarification.
Purpose of the Study:
- To determine which asthma control measure best correlates with GINA criteria in pediatric patients.
- To compare the effectiveness of the Asthma Control Test (ACT), Pediatric Asthma Control Test (PACT), and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) against GINA guidelines.
- To evaluate the utility of fractional exhaled nitric oxide (FeNO) and lung function parameters in assessing GINA-defined asthma control.
Main Methods:
- A cohort of pediatric asthma patients at a tertiary hospital was assessed post-treatment response.
- Evaluated measures included ACT/PACT, PAQLQ, FeNO, and lung function parameters.
- Asthma control status was determined by asthma specialists adhering to GINA criteria.
Main Results:
- The Asthma Control Test (ACT) demonstrated superior comparability with GINA criteria (κ=0.473) compared to PACT (κ=0.221) and PAQLQ (κ=0.150).
- For children aged 12 years and older, PAQLQ showed higher agreement with GINA criteria (κ=0.326).
- ACT correctly classified 75.9% of patients according to GINA, outperforming PACT (64.1%) and PAQLQ (62.9%). FeNO and lung function tests were not effective in revealing GINA-defined control status.
Conclusions:
- The Asthma Control Test (ACT) is a more comparable measure to GINA guidelines for assessing asthma control in children than PACT.
- PAQLQ and ACT show better correlation in older children (≥12 years), suggesting age-specific considerations for asthma control assessment.
- FeNO and lung function parameters were not reliable indicators of GINA-defined asthma control in this pediatric cohort.
Abstract:
Guidelines such as Global Initiative for Asthma (GINA) recommend disease control as the mainstay of asthma management. To investigate which measure of asthma control best correlates with the GINA criteria for determining asthma control in children. Child asthma-patients at a tertiary hospital were enrolled in the study after evaluation of response to treatment. Asthma control test (ACT)/pediatric asthma control test (PACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ), fractional exhaled nitric oxide (FeNO), and lung function parameters were evaluated. Patients were examined by asthma specialists and control status was evaluated based on GINA. The median age (interquartile range) of patients was 10.7 (8.4-12.9) years, 57.9% of patients were boys. Of 228 children, 84.2%, 9.6%, and 6.1% displayed "well-controlled", "partially controlled", and "uncontrolled" asthma, respectively, according to GINA. The patients with "partially controlled" and "uncontrolled" asthma were grouped as "not well-controlled." The cutoff levels were 22, 21, and 5.9 for PACT, ACT, and PAQLQ, respectively, for determining "well-controlled" asthma (P < 0.001). With these cutoff values, ACT exhibited higher comparability with GINA than PACT and PAQLQ (κ = 0.473, 0.221, and 0.150, respectively, P < 0.001). PAQLQ had higher agreement with GINA criteria in children ≥12 years old (κ = 0.326, P < 0.001 and κ = 0.151, P = 0.014, respectively). Correctly classified patients with PACT, ACT, and PALQLQ based on GINA with these cutoff levels were 93 (64.1%), 63 (75.9%), and 139 (62.9%), respectively. FeNO and lung function parameters were unsuccessful at revealing control status according to GINA. ACT is better than PACT for comparability with GINA. Better correlation of PAQLQ and ACT and better comparability of PAQLQ and GINA were evident in older children.
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