PURPOSE OF THE STUDY.
The goal of this study was to evaluate asthma control based on Global Initiative for Asthma (GINA) 2006, National Asthma Education and Prevention Program (NAEPP), Childhood Asthma Control Test (C-ACT), and physician’s assessment (PA).
This prospective study included 527 asthmatic children aged 4 to 11 years recruited over an 18-month period at an office visit. Children with a chronic illness in addition to asthma were excluded. Both tertiary pediatric pulmonology centers and general pediatric offices were used.
Demographic data, information on treatment, and number of severe exacerbations during the previous year were collected. Control was assessed using the following methods: (1) strict GINA 2006 criteria, (2) GINA without taking into account the exacerbation item, (3) NAEPP criteria, and (4) PA, blinded to the C-ACT score. Children and parents filled out the C-ACT.
Mean age of patients in the study was 7.7 years (28% were ≤6 years), 78% had a controller treatment, 58% reported ≥1 severe exacerbations, and C-ACT was ≤19 in 29.5%. Control was not achieved in 76.5%, 55%, 40%, and 34% according to GINA 2006 guidelines, NAEPP guidelines, GINA 2006 without exacerbation criteria, and PA, respectively. C-ACT was significantly lower in children ≤6 years (P = .002) or with severe exacerbations (P < .0001). According to PA, 89% of patients with a C-ACT >21 were controlled, and 85% of patients with a C-ACT <17 were not controlled.
This study found discrepancies between the various tools used to assess asthma control in children and in the impact of age and exacerbations. The cutoff point of 19 of C-ACT was not associated with the best performance compared with physician assessment. The determination of asthma control by C-ACT alone may underestimate uncontrolled asthma.
The study supports the use of C-ACT as a supplementary tool in asthma control assessment but points out a problem in relying too heavily on this instrument alone. It provides additional data for consideration of varying the cutoff points for controlled versus uncontrolled asthma. Assessment of lung function, when possible, and evaluation of exacerbations over a longer period of time, may result in better assessment of asthma control.
- Copyright © 2015 by the American Academy of Pediatrics