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Test of asthma control for youngsters introduced

Wed Oct 12, 2005 

By Larry Schuster

WASHINGTON (Reuters Health) - At the annual meeting of the American Academy of Pediatrics this week, a seven-item asthma control questionnaire that identifies children 4 years old to 11 who have poorly controlled asthma was unveiled.

Called the Childhood Asthma Control Test, or Childhood ACT, it is designed for use in a pediatrician's office and asks young children, with a caregiver's guidance, to respond to four of the questions, while the caregiver is asked to respond to three questions. It was developed by a working group of pediatric specialists in asthma and immunology, and sponsored by GlaxoSmithKline.

It complements a similar test already available for children 12 years or older that is supported by the American Lung Association, said Dr. Bradley E. Chipps, medical director of respiratory therapy, Sutter Medical Center, Sacramento, California, and co-author of the Childhood ACT validation study.

The researchers developed the test based on a trial of a 21-item questionnaire administered to 344 patients with asthma and their caregivers in nine specialist clinics in the United States. The results of the questionnaire were compared to specialists' ratings of asthma control based on patient history and spirometry -- a quick, simple lung function test performed in the doctor's office.

The researchers were able to reduce the 21 items to the seven items best able to discriminate a child's asthma control status.

In responding to the questionnaire, for each of four items, the child selects answers that range from a sad face to a smiley face, to indicate the level of impact their asthma is having on their life.

The children are asked:

--How is your asthma today?

--How much of a problem is your asthma when you run, exercise or play sports?

--Do you cough because of your asthma?

--Do you wake up during the night because of your asthma? 

The caregiver is asked questions on the impact of the child's asthma during the last for weeks, including:

--How many days per month did your child have any daytime asthma symptoms?

--How many days per month did your child wheeze during the day because of asthma?

--How many days per month did your child wake up during the night because of asthma?

According to the team, a score of 19 or less (in a scoring range of 0-27) identified poorly controlled asthma.

In a "validation" study, researchers found that the Childhood ACT scores discriminated between groups of children differing in the specialists' rating of asthma control, the need for change in therapy, and the percentage predicted FEV1 -- a widely used test that measures the amount of air a person can forcefully exhale over the course of 1 second.

Dr. Todd A. Mahr, of La Cross, Wisconsin, another author on the validation study, said of the earlier test for older children, it was "very good" for screening somebody who did not have asthma under control. "The problem is we needed one for the 4-to-11 year old age group." The new tool appears to fit the bill.

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