Determining pediatric asthma control in real-life: Comparison of
Pediatric Asthma Control Test, Asthma Control Test, Fractional exhaled
nitric oxide, Pediatric Asthma Quality of Life Questionnaire and Lung
function with GINA criteria
Abstract
Background Guidelines as Global Initiative for Asthma(GINA) recommend
disease control as the mainstay of asthma management. The performance of
the tools assessing in asthma control is challenging in real-life.
Methods Children and adolescents with asthma followed at a tertiary
research hospital were enrolled in the study after evaluation of
adherence to treatment. Asthma Control Test(ACT)/Pediatric Asthma
Control Test(PACT), Pediatric Asthma Quality of Life
Quesstionnaire(PAQLQ), fractional exhaled nitric oxide(FeNO) and lung
function were evaluated. Patients were examined by asthma specialists
blinded to the results of the tools and their control status were
evaluated based on GINA. Results The median age(interquartile range,IQR)
of the patients was 10.7(8.4-12.9) years, 57.9% were boys. Of 228
children, 84.2%, 9.6% and 6.1% had “well-controlled”,
“partially-controlled” and “uncontrolled” asthma, respectively. The
patients with “partially-controlled “ and “uncontrolled” asthma were
grouped as “not well-controlled”. The cut-off levels were 22, 21 and
5.9 for PACT, ACT and PAQLQ for determining “well-controlled”
asthma(p<0.001). With these cut-off values, ACT had the higher
compatibility with GINA than PACT and PAQLQ(κ=0.221, 0.473 and 0.150,
respectively, p<0.001). Correctly classified patients with
PACT, ACT and PALQLQ based on GINA with these cut-off levels were
93(64.1%), 63(75.9%) and 139(62.9%), respectively. FeNO and lung
function were unsuccessful at revealing control status according to
GINA. Conclusion ACT is better than PACT at compatibility with GINA.
Probably, it is because older children have a longer recall period than
younger ones. It would be better to use these tools for each patient by
comparing their own scores in real-life, instead of cut-off values.