Related Experiment Video
Updated: Jul 16, 2025
Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
Association between Childhood Asthma Control Test scores and lung pathophysiologic indicators in longitudinal
Xiaoxing Cui1, Xiaojian Zhou2, Zhen Li2
1Nicholas School of the Environment, Duke University, Durham, NC, USA.
Insights
Changes in the Childhood Asthma Control Test (C-ACT) scores reflect lung function changes in children with asthma. Specifically, worsening C-ACT scores correlate with decreased lung function and increased airway resistance, but not small airway measures.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Clinical Assessment Tools
Background:
- The Childhood Asthma Control Test (C-ACT) is validated for assessing asthma control in children aged 4-11.
- This study investigates if longitudinal changes in C-ACT scores correlate with pathophysiological changes in the lungs.
Purpose of the Study:
- To determine if changes in C-ACT scores reflect changes in lung function and inflammation.
- To explore the relationship between C-ACT scores and specific lung pathophysiologic indicators.
Main Methods:
- Thirty-seven children (5-10 years old) with mild/moderate asthma were monitored bi-weekly for 6 weeks.
- Assessments included C-ACT, airway mechanics, lung function (FEV1, FVC), and respiratory inflammation (FeNO).
- Linear mixed-effects models analyzed associations between C-ACT score changes and lung indicators.
Main Results:
- A two-point worsening in total C-ACT score correlated with decreased FEV1 (1.7%) and FVC (1.6%), and increased airway resistance (R5: 3.8%).
- Child-reported C-ACT worsening showed stronger associations with reduced FEV1/FVC and increased R5/R20.
- Caregiver-reported scores did not correlate with lung measures; total C-ACT correlated with FeNO in non-eosinophilic asthma.
Conclusions:
- Longitudinal C-ACT scores can reflect acute changes in large airway resistance and lung function in pediatric asthma.
- Small airway measures are crucial for a comprehensive assessment of asthma control.
- Asthma phenotype may influence the C-ACT's ability to reflect respiratory inflammation.
Background:
Childhood Asthma Control Test (C-ACT) is a well-validated questionnaire for asthma controls among 4-11 years old children. This study aims to examine if longitudinal C-ACT score changes could also reflect lung pathophysiologic changes.
Methods:
Thirty-seven children (43% female) aged 5 to 10 years old with mild or moderate asthma were followed up for 6 weeks with bi-weekly assessments of C-ACT, airway mechanics, lung function and respiratory inflammation. Associations of longitudinal changes in C-ACT score with lung pathophysiologic indicators were evaluated using linear mixed-effects models.
Results:
A two-point worsening of total C-ACT score (sum of child and caregiver-reported) was associated with significant decreases in forced expiratory volume during the 1st second (FEV1) by 1.7% (P=0.04) and forced vital capacity (FVC) by 1.6% (P=0.01) and increased total airway resistance [airway resistance at 5 Hz (R5)] by 3.8% (P=0.05). A two-point worsening in child-reported score was significantly associated with 3.1% and 2.5% reductions in FEV1 and FVC, respectively, and with increases in R5 by 6.5% and large airway resistance [airway resistance at 20 Hz (R20)] by 5.5%. In contrast, a two-point worsening of caregiver-reported score was associated with none of the concurrent lung pathophysiologic measurements. Worsening of total C-ACT score was significantly associated with increased respiratory inflammation [fractional exhaled nitric oxide (FeNO)] in a subset (n=23) of children without eosinophilic airway inflammation. C-ACT scores were associated with none of the small airway measures.
Conclusions:
In children with mild or moderate asthma, longitudinal C-ACT score changes could reflect acute changes in large airway resistance and lung function. Measures of small airway physiology would provide valuable complementary information for asthma control. Asthma phenotype may affect whether C-ACT score could reflect respiratory inflammation.
Related Concept Videos
01:26Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:29Asthma-I: Introduction
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.