Study On Application Of C-ACT And Modified Chinese TRACK In Asthma Children Under 6 Years Old

Objective: The current study aimed to evaluate the asthma control questionnaires the,Children’s Asthma Control Test(C-ACT)and the Chinese version of the Test for Respiratory and Asthma Control in Kids(TRACK),that are available for children younger than 6 years old,compared to the asthma control in Guideline for the Diagnosis and optimal management Asthma in children(2016,Chinese Guidelines),to investigate the relationship among the two questionnaires and lung function and FeNO.Methods: 194 asthmatic children under 6 years old,participated in the research,who were treated in the Pediatric Asthma Outpatient Clinic of the Second Hospital of Tianjin Medical University,from January to October 2019.All of them accepted the regular treatment of Inhaled corticosteroids(ICS)longer than 4 weeks,and followed up at least 3 months after enrollment.The caregivers and patients(4-6 years old)completed CACT and TRACK,and caregivers completed TRACK alone for children younger than 4years old at two clinical visits.Moreover,the physicians completed a Chinese Guideline-based asthma control survey at the same time.Lung function and FeNO were measured.The relationship of scores of two kind of tests and the asthma control categories,as well as the correlation among the scores and lung function and FeNO were analyzed.All results were analyzed by SPSS24.0.Results: 1.Demographic characteristics:194 patients were included,of these,132(68.04%)were male,and 62(31.96%)were female,with age of 1-6(4.8 ± 1.03)years old.The age distribution was as follows: 1-2 years old:4(20.6%),3-4 years old: 57(29.38%),5-6 years old:133(68.56%).170 patients completed C-ACT with the age of(5.07 ± 0.75)years,of whom,164 completed lung function and 166 completed FeNO at the first visit;165 patients completed lung function and 161 completed FeNO at follow-up.146 patients completed TRACK with an average age of(4.40 ± 0.87)years old,of whom,120 patients completed lung function and 126 completed FeNO at the first visit;123 completed lung function and 126 completed FeNO at follow-up.There was 73.71% with eczema;91.23% with allergic rhinitis;and 70.62% with a family history of allergy.2.C-ACT and asthma control assessment based on Chinese guideline(1)According to the Chinese guideline,the patients were divided into three groups,well controlled,partly controlled,and uncontrolled.It was found that with the increase of asthma control level,the C-ACT scores were significantly increased at baseline and follow-up,respectively,which showed significant difference among the groups.(2)ROC curve of C-ACT scores was made based on asthma control assessment of Chinese guideline.The area under the ROC curve at the baseline period was 0.963,and the cutoff value was 23,with the sensitivity of 89.29%,and the specificity of 93.71%,the positive predictive value of 89.29%,and the negative predictive value of 80.23%.During the follow-up period,the area under the ROC curve was 0.936,and the cutoff value was 23 points,with the sensitivity of 82.29%,the specificity of 93.24%,the positive predictive value of 94.05%,and the negative predictive value of 80.23%.(3)According to the scores of C-ACT and asthma control assessment of Chinese guideline,the patients were divided into two new group respectively,controlled group(well controlled group)and non-controlled group(partly controlled and uncontrolled groups).The consistency of the C-ACT and Chinese guideline for the assessment of asthma control levels was analyzed.It showed that the Cohen’s kappa coefficient was 0.75,95% CI(0.68-0.82),p <0.001,considered to be strong intensity consistency.3.TRACK and asthma control assessment based on Chinese guideline(1)According to the Chinese guideline,the patients were divided into three groups,well controlled,partly controlled,and poorly controlled.It was found that with the increase of asthma control level,the TRACK scores were significantly increased at baseline and follow-up,respectively,which showed significant difference among the groups.(2)ROC curve of TRACK scores was made based on asthma control assessment of Chinese guideline.The area under the ROC curve at the baseline period is 0.76,and the cutoff value is 82.5,with the sensitivity of 85.71%,and the specificity of 96.80%,the positive predictive value of 84.00%,and the negative predictive value of 97.58%.During the follow-up period,the area under the ROC curve is 0.885,and the cutoff value was 82.5,with the sensitivity of 91.78%,the specificity of 61.86%,the positive predictive value of 75.28%,and the negative predictive value of 91.07%.(3)According to the scores of TRACK and asthma control assessment of Chinese guideline,the patients were divided into two new group respectively,the patients were divided into two group respectively,controlled group(well controlled group)and noncontrolled group(partly controlled and uncontrolled groups).The consistency of the TRACK and Chinese guideline for the assessment of asthma control levels was analyzed.It showed that the Cohen’s kappa coefficient was 0.5,95% CI(0.41-0.85),p <0.001,considered to be medium intensity consistency.4.Correlation among scores of C-ACT and parameters of lung function and FeNO:The correlation coefficients of C-ACT score and FEV1% pred,PEF% pred,and MMEF% pred were 0.112,0.135,and 0.142,respectively,p<0.05,which showed a positive correlation.The correlation coefficient between C-ACT score and FeNO value was-0.057,p = 0.316,which showed no obvious correlation.5.Correlation among TRACK and parameters of lung function and FeNO:There was no obvious correlation between TRACK scores and FEV1% pred,r=0.06,p = 0.357.The correlation coefficients of TRACK scores and PEF% pred and MMEF% pred were 0.152 and 0.200,p<0.05,which was positively correlated.There was no obvious correlation between TRACK scores and FeNO,r=-0.070,p = 0.266.Conclusion: C-ACT and TRACK are of great significance for the assessment of asthma control in young children.They can partly replace the Chinese guideline for asthma assessment and some lung function parameters.As a reliable and effective auxiliary tool,they can help clinicians and parents to quantitatively assess the level of asthma control of patients under 6years old.