Up to 80% of asthmatic children may experience upper airway symptoms which are often perceived as coming from the lower airways. Currently, there are no validated questionnaires to assess upper airway contribution to pediatric asthma symptoms. The Sino-Nasal 5 (SN-5) questionnaire was previously validated for identifying radiographic confirmed sinus disease in children. In this study, we hypothesize that significant SN-5 scores (≥3.5) are associated with abnormal National Asthma Education and Prevention Program (NAEPP) based asthma impairment and control in asthmatic children. Retrospective data collected on children with asthma referred for pulmonary evaluation included age, gender, ethnicity, NAEPP asthma severity, asthma control (Test for Respiratory and Asthma Control in Kids (TRACK) < 5 years, Asthma Control Test (ACT) 5 years) and pulmonary function testing. Associations between SN-5 scores and asthma impairment and control were identified. Seventy-six children were evaluated; 38% were female with a mean age of 6.9 years. Significant SN-5 scores were associated with decreased control of daytime symptoms (odds ratio (OR): 0.16 (95% confidence interval (CI): 0.06–0.44)), night time awakenings (0.09 (0.03–0.29)), activity interference (0.2 (0.06–0.68)), NAEPP defined asthma control (0.32 (0.12–0.85)) and poor asthma control based on TRACK (p < 0.001) and ACT (p < 0.001). This suggests upper airways may play a larger role in perceived lower airway symptoms, and SN-5 may be beneficial in assessing the contribution of upper airway conditions on asthma control.
Purpose of StudyUp to 35% of asthmatic children have degrees of sleep disordered breathing (SDB) which may be perceived as uncontrolled asthma. Asthma diagnosis, classification and assessment of control are defined by the National Asthma Education Prevention Program (NAEPP) 2007 guidelines and include nighttime awakenings as one asthma impairment category. Unclear whether this stems from asthma or SDB. The Pediatric Sleep Questionnaire (PSQ) is validated to identify SDB in children; however associations with specific levels of NAEPP guideline's asthma related impairment have not been evaluated. We hypothesize that asthmatic children with impairment only in NAEPP nighttime awakenings, but not other categories, will have a positive PSQ score (>0.33), suggesting screening for SDB.Methods UsedWe performed a retrospective chart review of children (age 1–21 yrs) referred to a pediatric pulmonary clinic. Data collected included age, gender, BMI%, spirometry, PSQ, asthma control (TRACK <5 yrs, ACT ≥5 yrs), and NAEPP asthma severity, control and impairment. Significant PSQ scoring is >0.33 based on previous validation. Spirometry was performed in children ≥5 yrs. Statistical analysis performed with SPSS 22.Summary of Results76 inner-city children were included in this study; 38% female, mean age 6.9 y, and mean BMI% 69%. Significant PSQ scoring (>0.33 vs ≤0.33) was associated with night time awakenings (OR 11.4 [95% CI:3.7–35.2]) and decreased asthma control seen in TRACK (p<0.003) and ACT questionnaires (p<0.001). Overweight/obese status (BMI% ≥85), spirometry, asthma severity, activity interference and daytime symptoms were not associated with a significant PSQ score.ConclusionsIn asthmatic children, impairment in night time awakenings as defined by NAEPP guidelines was associated with a significant PSQ score, and poor asthma control, based on abnormal TRACK and ACT scores, however other NAEPP categories of impairment; daytime symptoms, activity interference, asthma severity and control, were not. This suggests that screening SDB with the PSQ in children with night time awakenings based on NAEPP criteria may detect underlying SDB. This may lead to further investigations, treatment and subsequent improvement in asthma symptoms. A prospective analysis in a larger cohort is recommended to validate these findings.
Purpose of StudyUp to 80% of asthmatic children may experience upper airway symptoms, including rhinitis, often perceived as coming from lower airways. Asthma diagnosis, classification and assessment of control are defined by the National Asthma Education Prevention Program (NAEPP) 2007 guidelines, but may understate the impact of the upper airway. We explored associations between Sino-Nasal 5 (SN-5) quality of life questionnaire, validated in radiographic confirmed sinus disease, and NAEPP asthma impairment in children. We hypothesize that children with NAEPP defined uncontrolled asthma will have abnormal SN-5 scores.Methods UsedWe performed a retrospective chart review of children (1–21 yr) referred to a pediatric pulmonary clinic for persistent asthma. Data collected include age, gender, BMI%, NAEPP asthma severity, SN-5, asthma control (TRACK children <5 y, ACT children ≥5 y) and pulmonary function testing (PFT). The primary analysis was to identify associations between SN-5 scores and levels of NAEPP guideline impairment: daytime symptoms, night time awakenings, activity interference and PFTs. Significant SN-5 scoring was defined as ≥3.5 based on prior studies. PFT was performed in children ≥5 y. Statistical analysis with SPSS 22.Summary of Results76 children were evaluated; 38% female, mean age 6.9 y and mean BMI% 69%. Significant SN-5 score (≥3.5 vs. <3.5) was associated with decreased control of daytime symptoms (OR 0.16 [95% CI:0.06–0.44]), night time awakenings (OR 0.09 [0.03–0.29]), activity interference (OR 0.2 [0.06–0.68]) and asthma control (OR 0.32 [0.12–0.85]). Those with SN-5 ≥3.5 had poor asthma control based on TRACK (p<0.002) and ACT (p<0.001). Age, gender, BMI%, asthma severity and PFTs were not associated with SN-5.ConclusionsIn persistent asthmatic children, NAEPP defined daytime, night time, activity related impairment and poor asthma control were associated with a significant SN-5 score; PFTs and NAEPP asthma severity were not. This suggests that upper airways may play a larger role in lower airway associated symptoms, and that SN-5 may be beneficial in assessing asthma symptoms. Recognizing and treating upper airway symptoms, an understated area in asthma guidelines, might improve overall asthma control. A prospective analysis in a larger cohort is recommended to evaluate these findings.
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