Chest

Chest

Volume 143, Issue 1, January 2013, Pages 117-122
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Original Research
Asthma
Disagreement Among Common Measures of Asthma Control in Children

https://doi.org/10.1378/chest.12-1070Get rights and content

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.

Section snippets

Participants and Setting

Children with chronic asthma attending routine follow-up examinations were enrolled. Inclusion criteria were as follows: known asthma based on recurrent cough or wheezing that responds to a bronchodilator6 (bronchodilator responsiveness determined by at least 12% reversibility of FEV1 after administration of an inhaled bronchodilator); aged 4 to 11 years; atopic with at least one positive skin prick test (a panel of Bermuda grass, corn pollen, five-grass mix, mold mix, cat hair epithelium, dog

Results

Eighty children were enrolled. Nine were subsequently excluded because three could not complete all assessment steps and six were found by the pediatrician at step 4 to have an acute attack. Seventy-one children (mean age, 8.4 years; median age, 9 years) completed the study, of whom 46 were boys aged 4 to 11 years (median, 8 years) and 25 girls aged 4 to 11 years (median, 9 years). All children were from lower- or middle-income families, and all were able to speak English. Sixty-one percent

Discussion

With respect to the aim of this study, overall agreement among testing methods to assess control of asthma was reached in 49.3% to 83.1% of assessments. Interparameter agreement using the κ statistic revealed poor (≤ 0.4) to moderate agreement (0.4-0.75) for all comparisons. Most tests were in poor agreement, and only the physiologic variables within spirometric assessment achieve moderate agreement.

When only a single measure of control is used, then 41 to 62 of the children with asthma

Conclusions

This study revealed significant disagreement among many of the testing methods used to assess asthma control. Assessment of multiple parameters, including biomarkers, physiologic measures, symptoms, and activity limitation, would probably be necessary to categorize asthma clinical status accurately.29

This study demonstrates that there is no easy answer to the measurement of asthma control. It seems likely that asthma control requires more than one end point in assessment and that both physician

Acknowledgments

Author contributions: Dr Green had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Green: contributed to the coordination of the study; data collection; and writing, review, and approval of the manuscript.

Dr Klein: contributed to writing, review, and approval of the manuscript.

Dr Becker: contributed to the statistical analysis and review and approval of the manuscript.

Dr Halkas: contributed to the data

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    • Cited by (0)

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

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    Copyright © 2013 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.