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Asthma is one of childhood's most common chronic diseases with significant morbidity. Regular monitoring of asthma control is an essential component of asthma management. Based on asthma control, asthma therapy is modified, or reasons for poor asthma control are assessed. There are many tools to evaluate asthma control in children, and the most commonly used are the asthma control test, ACT [1] (above 11 y of age), childhood asthma control test, CACT [2] (between 4 to 11 y of age), Global Initiative for Asthma (GINA) guidelines [3]. There is always a debate about which tool is better for assessing asthma control in children. Further, it will be interesting to know whether these asthma control tools correlate with pulmonary function tests.
In a study by Jahnavi et al. in this issue, the authors assess asthma control by ACT/CACT and GINA in 49 newly diagnosed asthmatic children and compare it against spirometry [4]. The authors assessed the children at baseline and after three months. Asthma control by GINA, ACT/CACT score and spirometry parameters improved significantly from baseline to three months [4]. There was a significant positive correlation between ACT gain vs. forced expiratory volume in 1 s (FEV1) gain and ACT gain vs. peak expiratory flow rate (PEFR) gain [4]. Authors included only treatment naïve asthmatic children, with only 2% having well-controlled asthma at baseline. Therefore, it is difficult to say if the same results can be extrapolated to asthmatic children on treatment. Further, the sample size is small in the current study.
The current study's findings concord with a few studies, whereas some studies could not replicate the findings. Some discrepancies in results may be due to differences in inclusion criteria (treatment naïve patients or on-treatment patients) or different duration of the follow-up period. A study even reported that ACT reflects lung function tests and correlates with inflammation, as assessed by fractional exhaled nitric oxide (FeNO) [5]. A study evaluated ACT/CACT score, spirometry and FeNO in 612 children and reported that among children with good control by ACT/CACT, 46% of children had an abnormality in either spirometry or FeNO, and among children with poor control by ACT/CACT, 49% children had normal FeNO and spirometry. They also reported that FEV1 and FEV1/FVC correlated with ACT but not CACT.
To conclude, which tool is best to monitor children with asthma is still debatable. Using a tool to monitor asthma control is always good as it provides a measurable asthma control status. Studies need to evaluate whether a combination of tools is better than a single tool in asthma control and whether it is helpful in modifying the therapy.
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Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2022. Available at: https://ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022-FINAL-22-07-01-WMS.pdf. Accessed on 1st May 2023.
Jahnavi M, Gowrishankar NC, Nedunchelian K. Comparison of asthma control among children 5–18 years of age by asthma control test questionnaire of global initiative for asthma 2017 (GINA-2017) against spirometry. Indian J Pediatr. 2022. https://doi.org/10.1007/s12098-022-04162-8.
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Jat, K.R. Which Tool to Monitor Asthma Control in Children: The Debate Continues!. Indian J Pediatr 90, 749 (2023). https://doi.org/10.1007/s12098-023-04669-8
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DOI: https://doi.org/10.1007/s12098-023-04669-8