PURPOSE: In spite of the great development of international guidelines for the diagnosis and the treatment of asthma, there is continuing evidence of poor control of childhood asthma. Aim of this work was to evaluate the subjective asthma control test (ACT) against the objective impulse oscillation system (IOS) measures of the airways resistance in asthmatic children.
METHODS: This study included 35 asthmatic children diagnosed with bronchial asthma according to GINA guidelines 2009. All the study children were subjected to the following; full medical history, thorough clinical examination and basic spirometric FEV1 measurements (to fulfill GINA doctor's subjective assessment for asthma control). Then; the children's subjective assessment by ACT (using an Arabic version of ACT) was done. Finally; Impulse Oscillation test (IOS) was done for all children to compare their objective results with previous subjective results of asthma control.
RESULTS: Score 19 was the cut off value differentiating children's asthma control (compared to the gold standard IOS cut off values). Thirty two patients were considered controlled by the CACT/ACT (score >19) versus 28 children using IOS assessment. Only 3 patients were considered uncontrolled by ACT tests (score ≤ 19) versus 7 children using IOS. Moderate agreement between CACT /ACT test for asthma control and R5 results; kappa test= 0.54 (P <0.0001) was reported. While agreement between IOS results and GINA tool for asthma control was much less significant; kappa test= 0.36 P> 0.05. Nevertheless; there was highly significant negative correlations between total scores of CACT/ACT and values of IOS (R5) and (R20); r=- 0.47, r= -0.51 and P=0.004, P=0.002 respectively. The correlation coefficient for the internal consistency of the CACT/ACT was 0.89 as an evidence for ACT reliability. Also accuracy of CACT /ACT was assured by calculating area under the ROC curve (AUC) and it was 0.900.
CONCLUSIONS: This study confirms that asthma control test (ACT) is a valid and cost effective instrument for assessment of control in asthmatic children.
CLINICAL IMPLICATIONS: This study manifests that the subjective patients' assessment using childhood asthma control test (ACT) could be superior to the subjective doctors' assessment using GINA tool for pediatric asthma control .
DISCLOSURE: The following authors have nothing to disclose: Malak Shaheen, Mona El Ganzoury, Emad Mohamed
No Product/Research Disclosure Information