October 12, 2005

Test of asthma control for youngsters introduced

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

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

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.