Disagreement Among Common Measures of Asthma Control in Children

Green, Robin J.; Klein, Max; Becker, Piet J.; Halkas, Andrew; Lewis, Humphrey; Kitchin, Omolemo P.; Moodley, Teshni; Masekela, Refiloe

doi:10.1378/chest.12-1070

Cited by 36 publications

(66 citation statements)

References 22 publications

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“…Conversely, the increased FeNO may be an actual indicator of more intense airway inflammation, not sufficiently controlled by the current maintenance treatment. The latter is supported by reports demonstrating that the correlation between asthma symptoms, pulmonary function tests and airway inflammation is limited, and that such determinations may reflect different disease domains [26-28]. Furthermore, our data showing a significant correlation between the FeNO and ACQ-7 decrements from visit 1 to visit 2, is consistent with the idea that the FeNO values actually reflect airway inflammation in this subpopulation of patients.…”

Section: Discussionsupporting

confidence: 91%

Exhaled Nitric Oxide Fraction as an Add-On to ACQ-7 for Not Well Controlled Asthma Detection

et al. 2013

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BackgroundThe measurement of fractional nitric oxide concentration in exhaled breath (FeNO), a noninvasive indicator of airway inflammation, remains controversial as a tool to assess asthma control. Guidelines currently limit asthma control assessment to symptom and spirometry based appraisals such as the Asthma Control Questionnaire-7 (ACQ-7). We aimed at determining whether adding FeNO to ACQ-7 improves current asthma clinical control assessment, through enhanced detection of not well controlled asthma.MethodsAsthmatic subjects, classified as not well controlled as per ACQ-7 on regular clinical practice, were included in a prospective, multicenter fashion, and had their maintenance treatment adjusted on visit 1. On follow-up (visit 2) four weeks later, the subjects were reevaluated as controlled or not well controlled using ACQ-7 versus a combination of FeNO and ACQ-7.ResultsOut of 381 subjects enrolled, 225 (59.1%) had not well controlled asthma on visit 2 as determined by ACQ-7, and 264 (69.3%) as per combined FeNO and ACQ-7. The combination of FeNO to ACQ-7 increased by 14.8% the detection of not well controlled asthma following maintenance therapy adjustment.ConclusionsThe addition of FeNO to ACQ-7 increased the detectability of not well controlled asthma upon adjustment of maintenance therapy. Adding a measure of airway inflammation to usual symptom and spirometry based scores increases the efficacy of current asthma clinical control assessment.

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Section: Discussionsupporting

confidence: 91%

Exhaled Nitric Oxide Fraction as an Add-On to ACQ-7 for Not Well Controlled Asthma Detection

et al. 2013

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“…[2][3][4][5][6][7] Recently, it has been proved that fractional exhaled nitric oxide (F ENO ) results are in disagreement with other measurements of asthma control in children, namely spirometry, children's asthma control test, and conventional clinical assessment. 8 Green et al 8 showed that mean F ENO in pediatrician-judged uncontrolled asthma was double that in controlled asthma. F ENO correlates with bronchial reactivity 9 and decreases when anti-inflammatory asthma therapy in children is used.…”

Section: Introductionmentioning

confidence: 99%

Spirometry-Adjusted Fraction of Exhaled Nitric Oxide Allows Asthma Diagnosis in Children, Adolescents, and Young Adults

Grzelewski

Stelmach

et al. 2015

Respir Care

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.81 ppb/L/s. Only the ratios described above were closely correlated with the diagnosis of asthma and with one another. They significantly differed between subjects with asthma and healthy subjects as well as between females and males. Only FEF 25-75% /F ENO and F ENO /FEF 25-75% values were significant predictors of any sensitization in the studied subjects. We found higher sensitivity than specificity and higher positive predictive value than negative predictive value for FVC/F ENO , FEV 1 /F ENO , and FEF 25-75% /F ENO and found a mirror image for reverse parameters. However, the positive predictive values and negative predictive values were not clearly convincing with respect to diagnostic accuracy in the case of the new parameters proposed. CONCLUSIONS: We propose new lung function/lung inflammation ratios by which it may become possible to diagnose asthma in children and adolescents on the basis of a subject's spirometry and F ENO measurements. We believe that our ratios are only supportive of the universally used parameters in the process of diagnosing asthma. (ClinicalTrials.gov registration NCT01805635.)

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“…Others have described how the previously established cut points for the ACT may over- or underestimate asthma control categories as compared to GINA [16]. The lack of agreement among different measures of control has also been documented in the literature [17–18]. …”

Section: Discussionmentioning

confidence: 99%

Development and validation of the RAND Asthma Control Measure

et al. 2014

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Patient-based measures for asthma control are important in assessing the worldwide impact of this highly prevalent chronic illness.We sought to refine an asthma symptom scale that RAND had previously developed to shorten it and validate it further, as well as reflect updated international expert definitions of asthma control. We conducted rigorous psychometric testing of new and adapted self-administered survey items in a sample of 2032 adults with asthma.The reliability and preliminary validity of the resulting measure, henceforth referred to as the RAND Asthma Control Measure (RAND-ACM), matched or exceeded that of the original RAND measure and others in the literature. RAND-ACM scores for worse asthma control were significantly associated with worse asthma-related quality of life, increased asthma-related healthcare use, Hispanic ethnicity and lower educational level. Evidence for internal consistency was strong with a Cronbach’s α of 0.84. We also found adequate concordance between the RAND-ACM and the Global Initiative for Asthma categories of “uncontrolled”, “partly controlled” and “controlled” asthma.The RAND-ACM, a five-item self-reported asthma control survey measure, performs well in a large ethnically-diverse sample of US adults with asthma and provides a cost-free alternative to other asthma control measures currently available.

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Disagreement Among Common Measures of Asthma Control in Children

Cited by 36 publications

References 22 publications

Exhaled Nitric Oxide Fraction as an Add-On to ACQ-7 for Not Well Controlled Asthma Detection

Exhaled Nitric Oxide Fraction as an Add-On to ACQ-7 for Not Well Controlled Asthma Detection

Spirometry-Adjusted Fraction of Exhaled Nitric Oxide Allows Asthma Diagnosis in Children, Adolescents, and Young Adults

Development and validation of the RAND Asthma Control Measure

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