Assessing asthma control: Symptom scores, GINA levels of asthma control, lung function, and exhaled nitric oxide

Background The childhood asthma control test (C-ACT) is a validated symptom score for assessing asthma control in children. We used a slightly modified version (C-ACTM) of the German C-ACT and compared our results with the literature, correlated the children's part of C-ACT (C-ACTchildren) with a visual analogue scale (VASchildren), explored the agreement between C-ACTM and GINA levels of asthma control, as well as the relationship between C-ACTM and lung function and exhaled nitric oxide (FeNO). Methods: We investigated 107 children with a diagnosis of asthma. The study protocol consisted of a clinical examination, assessment of asthma control according to GINA guidelines, administration of C-ACT M, VAS children, lung function, and FeNO. Results: Of our patients 66% had, according to GINA, partly controlled-/ uncontrolled asthma, 18% were uncontrolled according to C-ACT M. Children with partly controlled-/ uncontrolled asthma according to GINA had lower C-ACT M scores than did children with controlled asthma (16.1 +/- 3.6 SD vs. 25.4 +/- 1.8 SD; P < 0.000), and children with a C-ACT(M) score <= 19 had poorer lung function (mean FEV1% predicted 81.5 +/- 13.5 SD vs. 94.2 +/- 12.1 SD; P = 0.002). Spearman's rank correlation coefficients revealed significant correlations between all symptom scores. Multiple linear regression adjusted for age, gender, FEV1 and FeNO demonstrated a significant relationship between C-ACT M, VAS children, and FEV1 (P = 0.003, resp. < 0.000), but no significant correlation between C-ACT M, VAS children, and FeNO. Conclusions: The German version of C-ACT M is valid and useful for monitoring children with asthma along with tests aimed to follow up lung function and airway inflammation. Concordance between C-ACT M and GINA is moderate, because asthma control assessed by C-ACT M allows more symptoms and lung function is not included in the scoring. Pediatr Pulmonol. 2012; 47: 113-118. (C) 2011 Wiley Periodicals, Inc.