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Original Research: ASTHMA |

Disagreement Among Common Measures of Asthma Control in ChildrenAsthma Control Measurements in Children

Robin J. Green, PhD, FCCP; Max Klein, FCP; Piet Becker, PhD; Andrew Halkas, FC, Paed, FCCP; Humphrey Lewis, MMed; Omolemo Kitchin, Cert Pulm(SA) Paed, FCCP; Teshni Moodley, Cert Pulm(SA) Paed; Refiloe Masekela, Cert Pulm(SA) Paed, FCCP
Author and Funding Information

From the Division of Pulmonology (Drs Green, Klein, Kitchin, Moodley, and Masekela), Department of Paediatrics and Child Health, University of Pretoria, Pretoria; Biostatistics Unit (Dr Becker), South African Medical Research Council, Pretoria; and Paediatricians in Private Practice (Drs Halkas and Lewis), Gauteng, South Africa.

Correspondence to: Robin J. Green, PhD, FCCP, Department of Paediatrics, PO Box 667, Pretoria 0001 South Africa; e-mail: robin.green@up.ac.za


Funding/Support: This study was supported by the Division of Pulmonology Research Fund, Department of Paediatrics, University of Pretoria.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):117-122. doi:10.1378/chest.12-1070
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Background:  Asthma is a worldwide problem. It cannot be prevented or cured, but it is possible, at least in principle, to control asthma with modern management. Control usually is assessed by history of symptoms, physical examination, and measurement of lung function. A practical problem is that these measures of control may not be in agreement. The aim of this study was to describe agreement among different measures of asthma control in children.

Methods:  A prospective sequential sample of children aged 4 to 11 years with atopic asthma attending a routine follow-up evaluation were studied. Patients were assessed with the following four steps: (1) fraction of exhaled nitric oxide (FENO), (2) spirometry, (3) Childhood Asthma Control Test (cACT), and (4) conventional clinical assessment by a pediatrician. The outcome for each test was coded as controlled or uncontrolled asthma. Agreement among measures was examined by cross-tabulation and κ statistics.

Results:  Eighty children were enrolled, and nine were excluded. Mean FENO in pediatrician-judged uncontrolled asthma was double that of controlled asthma (37 parts per billion vs 15 parts per billion, P < .005). There was disagreement among measures of control. Spirometric indices revealed some correlation, but of the unrelated comparisons, those that agreed with each other most often (69%) were clinical assessment by the pediatrician and the cACT. Worst agreement was noted for FENO and cACT (49.3%).

Conclusion:  Overall, different measures to assess control of asthma showed a lack of agreement for all comparisons in this study.

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