Development of a nomogram to estimate the quality of life in asthmatic children using the Childhood Asthma Control Test

Montalbano, Laura; Cilluffo, Giovanna; Gentile, Manuel; Ferrante, Giuliana; Malizia, Velia; Cibella, Fabio; Viegi, Giovanni; Passalacqua, Giovanni; Grutta, Stefania La

doi:10.1111/pai.12571

Cited by 15 publications

(13 citation statements)

References 32 publications

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“…We found that 78% of the children had uncontrolled disease, defined by an increase of at least 12% of the FEV 1 after salbutamol or respiratory symptoms with exhaled NO level above than 35 ppb. This figure is fairly similar to other studies that reported about 75% uncontrolled asthma between 5 and 18 years of age …”

Section: Discussionsupporting

confidence: 92%

“…This figure is fairly similar to other studies that reported about 75% uncontrolled asthma between 5 and 18 years of age. 10,23,30,31 In our study, the ratio of exhaled NO/FEF 25%-75% arises as the best to assess asthma control, while the exhaled NO adjusted for FEV 1 as A moderate-to-strong agreement between spirometry-adjusted fraction of exhaled NO cut-off levels and those from the ATS 3 was ob- is probably due to growth-related increase in the airway area producing NO. Therefore, the spirometry adjustment could be regarded as a way to normalize this growth effect.…”

Section: Discussionmentioning

confidence: 52%

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Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Martins

Silva

Severo

et al. 2017

Pediatric Allergy Immunology

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Spirometry and exhaled nitric oxide are two important complimentary tools to identify and assess asthma control in children. We aimed to determine the ability of a new suggested spirometry-adjusted fraction of exhaled nitric oxide (NO) index in doing that. A random sample of 1602 schoolchildren were screened by a health questionnaire, skin prick tests, spirometry with bronchodilation and exhaled NO. A total of 662 children were included with median (IQR) exhaled NO 11(14) ppb. Receiver operating characteristic (ROC) curves using exhaled NO equations from Malmberg, Kovesi and Buchvald, and spirometry-adjusted fraction of exhaled NO values were applied to identify asthmatic children and uncontrolled asthma. Receiver operating characteristic (ROC) curves failed to identify asthmatic children (all AUC < 0.700). Spirometry-adjusted fraction of exhaled NO/FEV (AUC = 0.712; P = .010) and NO/FEF (AUC = 0.735 P = .004) had a fair and increased ability to identify uncontrolled disease compared with exhaled NO (AUC = 0.707; P = .011) or the Malmberg equation (AUC = 0.701; P = .014). Sensitivity and specificity identifying non-controlled asthma were 59% and 81%, respectively, for the cut-off value of 9.7 ppb/L for exhaled NO/FEV , and 40% and 100% for 15.7 ppb/L/s for exhaled NO/FEF . Exhaled NO did not allow to identify childhood asthma. Spirometry-adjusted fraction of exhaled NO performed better-assessing asthma control in children. Thus, although more validation studies are needed, we suggest its use in epidemiological studies to assess asthma control.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 52%

Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Martins

Silva

Severo

et al. 2017

Pediatric Allergy Immunology

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“…This is supported by Luskin et al, who showed that a greater severity and number of exacerbations were associated with a decrease in asthma-specific QoL [27]. Furthermore, the association between the asthma level of control and asthma-specific QoL we found is consistent with other studies focusing on asthma-specific QoL in children [1,[6][7][8][9][10][11][12][27][28][29][30][31][32]. It is known that chronic rhinitis in children with asthma is not only frequently occurring but also an underestimated problem by both patients, parents, and doctors [3].…”

Section: Discussionsupporting

confidence: 91%

Longitudinal Relationships between Asthma-Specific Quality of Life and Asthma Control in Children; The Influence of Chronic Rhinitis

Vliet

Essers

Winkens

et al. 2020

JCM

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Managing pediatric asthma includes optimizing both asthma control and asthma-specific quality of life (QoL). However, it is unclear to what extent asthma-specific QoL is related to asthma control or other clinical characteristics over time. The aims of this study were to assess in children longitudinally: (1) the association between asthma control and asthma-specific QoL and (2) the relationship between clinical characteristics and asthma-specific QoL. In a 12-month prospective study, asthma-specific QoL, asthma control, dynamic lung function indices, fractional exhaled nitric oxide, the occurrence of exacerbations, and the use of rescue medication were assessed every 2 months. Associations between the clinical characteristics and asthma-specific QoL were analyzed using linear mixed models. At baseline, the QoL symptom score was worse in children with asthma and concomitant chronic rhinitis compared to asthmatic children without chronic rhinitis. An improvement of asthma control was longitudinally associated with an increase in asthma-specific QoL (p-value < 0.01). An increased use of β2-agonists, the occurrence of wheezing episodes in the year before the study, the occurrence of an asthma exacerbation in the 2 months prior to a clinical visit, and a deterioration of lung function correlated significantly with a decrease in the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) total score (p-values ≤ 0.01). Chronic rhinitis did not correlate with changes in the PAQLQ score over 1 year. The conclusion was that asthma control and asthma-specific QoL were longitudinally associated, but were not mutually interchangeable. The presence of chronic rhinitis at baseline did influence QoL symptom scores. β2-agonist use and exacerbations before and during the study were inversely related to the asthma-specific QoL over time.

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“…Baseline characteristics were recorded through standardized questionnaires administered to parents/caregivers [20]. The PACQoL nomogram [21] was used for estimating QoL starting from the Childhood Asthma Control Test (C-ACT) [22]; adherence to treatment was assessed through the Medication Adherence Report Scale (MARS-9) [23]. Spirometry parameters were assessed by Lab (Pony FX portable spirometer, Cosmed, Rome, Italy) spirometry before and after the bronchodilator (BD) test performed in accordance with ATS/ERS guidelines [24] as well as by the Smart One ® (MIR Medical International Research, Rome, Italy), a portable spirometer connected to a Bluetoothenabled smartphone (for a detailed description see Supplementary Material).…”

Section: Study Assessmentsmentioning

confidence: 99%

Targeting quality of life in asthmatic children: The MyTEP pilot randomized trial

Montalbano

Ferrante

Cilluffo

et al. 2019

Respiratory Medicine

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Background: Quality of life (QoL) is an important outcome in the management of children with asthma. Mobile Health (m-Health) and Therapeutic Education Programs (TEPs) are increasingly recognized as essential components of pediatric asthma management to improve disease outcomes. Objective: To evaluate the effect of an education program (MyTherapeutic Education Program, MyTEP) that couples multidisciplinary TEP intervention with an m-Health Program (mHP) in improving QoL in asthmatic children.Methods: This single-center study employed a nonblinded randomized clinical trial design. Italian-speaking children (6-11 years) with mild-moderate asthma were eligible for participation. Participants were randomly paired 1:1 with a control group that received mHP (smartphone app) or an intervention group that received MyTEP (TEP plus a smartphone app). Patients were followed up for 3 months. Descriptive statistics, Least Square (LS) mean change and Generalized Linear Mixed model were used for analysis. Results: Fifty patients were enrolled. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) score improved in both MyTEP (p = 0.014) and mHP (p = 0.046) with the minimally clinically significant difference of ⩾0.5 points reached in 23% of MyTEP and in 16% of mHP. Changes in PAQLQ scores were significantly greater in MyTEP than in mHP (LS mean difference: 0.269 p = 0.05). PAQLQ score was: positively associated with MyTEP (p = 0.023) and study time (p = 0.002); and inversely associated with current passive smoke exposure (p = 0.003). Conclusion: Despite the small sample size and short observation period, this study demonstrated that implementing a multidisciplinary TEP with an m-Health program results in gains in QoL of children with asthma.

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Development of a nomogram to estimate the quality of life in asthmatic children using the Childhood Asthma Control Test

Cited by 15 publications

References 32 publications

Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Longitudinal Relationships between Asthma-Specific Quality of Life and Asthma Control in Children; The Influence of Chronic Rhinitis

Targeting quality of life in asthmatic children: The MyTEP pilot randomized trial

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