Correlación y concordancia entre instrumentos de control del asma en niños

Abstract

Introduction:It has been shown that asthma control and quality of life in children have moderate correlation, however FEV 1 would have only a weak correlation with these control parameters. Our objective was to measure clinical correlation and concordance between parameters of pediatric asthma control in Chilean children. Methods: Study carried out in the Unit of Respiratory Diseases, Roberto del Río Children's Hospital, between November 2009 and May 2010, in a series of persistent asthmatic children between 12 and 17 years old. We measured the correlation and agreement between asthma quality of life (PAQLQ Juniper), asthma control (ACT) and FEV 1 (percentage predicted). We used coeffi cient of Spearman rank correlation (rs) and kappa index. The sample size was calculated considering a power of 80% and p < 0.05. Results: We enrolled 88 patients, average age 13.4 years old, 61% male. Correlation PAQLQ and ACT (rs: 0.48), ACT and FEV 1 (rs: 0.11), PAQLQ and FEV 1 (rs:-0.1). Concordance PAQLQ < 6 points and ACT < 20 points (kappa: 0.46). Concordance ACT < 20 points with FEV 1 < 80% (kappa: -0.02), concordance PAQLQ < 6 points with FEV 1 < 80% (kappa: -0.02).Conclusions: The quality of life and asthma control have moderate correlation. FEV 1 weakly correlation with ACT and negative correlation with PAQLQ. The best cut-off point to identify uncontrolled asthma was obtained with ACT < 20 points and PAQLQ Juniper < 6 points. FEV 1 <80% do not have good agreement with ACT and PAQLQ to detect uncontrolled asthma. ResumenIntroducción: Se ha demostrado que el control del asma y la calidad de vida en niños se correlacionan en forma moderada, sin embargo, el VEF 1 sólo tendría una correlación débil con dichos indicadores de control. El objetivo de este estudio fue medir la correlación clínica y concordancia entre indicadores de control del asma pediátrica en niños chilenos. Pacientes y Métodos: Estudio realizado en el policlínico de enfermedades respiratorias del Hospital Roberto del Río, entre noviembre de 2009 y mayo de 2010, con un grupo de asmáticos persistentes de 12 a 17 años. Se midió la correlación y concordancia entre calidad de vida (PAQLQ de Juniper), control del asma (ACT) y VEF 1 (porcentaje del predicho). Se utilizó el coefi ciente de correlación por rangos de Spearman (rs) e índice de kappa. El tamaño muestral se calculó considerando un poder de 80% y p < 0,05. Resultados: Se enrolaron 88 pacientes, promedio de edad 13,4 años, 61% de género masculino. Correlación PAQLQ y ACT (rs: 0,48), ACT y VEF 1 (rs: 0,11), PAQLQ y VEF 1 (rs:-0,1). Concordancia PAQLQ < 6 puntos y ACT< 20 puntos (kappa: 0,46). Concordancia ACT < 20 puntos con VEF 1 <80% (kappa: -0,02), concordancia PAQLQ < 6 puntos con VEF 1 < 80% (kappa: -0,02). Conclusiones: La calidad de vida y el control del asma tienen correlación moderada. El VEF 1 presenta correlación débil con ACT y negativa con PAQLQ. El mejor punto de corte para detectar asma no controlada se obtuvo con ACT < 20 puntos y PAQLQ de Juniper < 6 puntos. EL VEF 1 < 80% no tiene buena c...

Is there an association between the value of forced expiratory volume in the 1st second, the Asthma Control Test and a Control Framework by Global Initiative for asthma in asthmatic children and adolescents treated with inhaled corticosteroids?

“…The study remained on 56 patients who met the criteria: use of IC regularly, either alone or in combination with long-acting beta 2 agonist, at least 3 months and had none of the conditions (associated pulmonary comorbidity, inadequately performed spirometric tests, or incorrect completion of the C-ACT/ACT questionnaire). In the study sample (56 children) , it was found a predominance of males (58.9%) and a median age of 12 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) years. There was a statistical association between FEV1 and GINA values (p <0.01), as well as between FEV1 values and those of C-ACT/ACT scores (p <0.01) in relation to controlled and untreated patients.…”

“…The results found in our study are similar to those of Fuhlbrigge et al 12 , who concluded that FEV 1 is associated with important clinical outcomes in children with asthma, such as symptoms, exacerbations and health care utilization. However, Vidal et al 13 in a study of 88 patients aged 12 to 17 years concluded that FEV 1 would not be an adequate instrument to monitor asthma control in children, since most children with asthma have normal FEV 1 values. Corroborating our study, Yasunori et al 14 analyzed 258 asthmatic children aged 5-11 years and found a positive correlation between C-ACT score and FEV 1 .…”

“…Resultados: Do total de prontuários avaliados (72), 16 crianças foram excluídas por não preencherem os critérios exigidos para realização da espirometria. A amostra estudada (56 crianças) apresentou predomínio do sexo masculino (58,9%) e mediana de idade igual a 12 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) anos. Observou-se associação entre os valores de VEF1 e o GINA (p<0,01).…”

Associação Entre a Fração Exalada De Óxido Nítrico E Dados Da Espirometria E O Controle Clínico Da Asma Em Crianças E Adolescentes

“…Fuhlbrigge et al in 2006 found similar results, 14 which concluded that FEV 1 is widely associated with important clinical outcomes in children with asthma such as symptoms, exacerbations, and use of health care. Rather, Vidal et al 15 in study with 88 patients between 12 and 17 years of age found that FEV 1 is not an adequate instrument to monitor asthma control in children and adolescents, as much of asthmatic children and adolescents have FEV 1 values within the range of normality.…”