Test for respiratory and asthma control in preschool kids in the emergency department as a predictor of wheezing exacerbations

Abstract

Objective The test for respiratory and asthma control in kids (TRACK score) is a standardized questionnaire tool validated to identify poor symptom control in children with stable preschool wheeze. This study determined if TRACK score measured within 5 days of an Emergency Department (ED) visit for acute wheezing predicts a subsequent wheezing exacerbation requiring an ED visit and/or treatment with systemic corticosteroids within 3 months. Methods This was a single‐center prospective cohort study of children aged 36 to 71 months who presented to the ED with an acute episode of wheezing and had TRACK score measured at a clinic visit within 5 days of the index ED encounter, focused on information about symptoms occurring before the onset of the current acute episode. The outcomes were the independent association of a repeat wheezing exacerbation with the overall TRACK score (primary) and with mutually uncorrelated TRACK items (secondary), adjusted for sex and atopy. Results We enrolled 102 children; median age 52.3 (44.1, 59.9) months, 59% males. Of these, 33 (32.4%) had further wheezing exacerbations. For each 10 unit decrease in TRACK, the odds of a future exacerbation was 1.38 (95% CI, 1.10‐1.75); male sex demonstrated OR, 5.13 (1.84‐14.33). A model that included TRACK items reflecting more than equal to 1 awakenings for wheezing in the past 4 weeks, receipt of more than equal to 2 courses of corticosteroids in the last year and male sex was predictive of wheezing exacerbations: OR, 6.43 (2.18‐19.00). Conclusion In preschoolers with acute wheezing episodes in the ED, we have identified the TRACK score components which, together with male sex, can be used to identify children at risk of future exacerbations requiring referral for specialized care. These results need to be confirmed and validated in other populations enrolled at multiple sites before they can be implemented in practice.

The Relationship of the Test for Respiratory and Asthma Control in Kids Initial Score on the Prognosis of Pre-school Children With Asthma: A Prospective Cohort Study

“…However, the TRACK score in previous studies was an assessment of the current situation, a cross-sectional comparison. A 3-month prospective cohort study conducted by Harel-Sterling et al showed that 60 was also the best predictor of wheezing exacerbations for pre-schoolers who visited the emergency department (ED) for wheezing ( 17 ). The best cut-off point of TRACK score in prognostic prediction should be further discussed in future studies.…”

Modeling the conversion between specific IgE test platforms for nut allergens in children and adolescents

“…This study was approved by the ethics board of the Hospital for Sick Children (REB #:1000053791) and the Medical University of Vienna (EK Nr 2302/2016). Additionally, 42 children with sensitizations were selected from the Wheezy ER study on pre‐school asthma between 3 and 6 years of age (REB #:1000041089), based on inclusion criteria reported previously 16,17 . These children presented to the Emergency Department at the Hospital for Sick Children with an acute wheezing exacerbation, a history of at least two wheezing episodes during the last 12 months, and displayed sensitization to food and/or inhalant allergens 18 …”

Prediction of Asthma Exacerbations in Children

“…a personal FeNO device, and a dedicated smartphone app, has been shown to improve asthma control and the quality of life of asthmatic patients [183,184]. The Biomedical Real-Time Health Evaluation (BREATH) platform is a similar tool that focuses on pediatric patients [185].…”

“…An advanced monitoring tool, the myAirCoach system, which includes an inhaler adapter, an indoor air-quality monitor, a physical activity tracker, a portable spirometer, a personal FeNO device, and a dedicated smartphone app, has been shown to improve asthma control and the quality of life of asthmatic patients [183,184]. The Biomedical Real-Time Health Evaluation (BREATH) platform is a similar tool that focuses on pediatric patients [185].…”