Childhood Asthma Control Test and spirometry values in school-age children.

OBJECTIVE: To determine the relationship between child and parent reports of asthma control using the Childhood Asthma Control Test (C-ACT) and spirometry. METHODS: This descriptive study included 648 children ages 5-11 years from a school-based asthma program. Not well-controlled asthma was defined as forced expiratory volume in 1 s (FEV1) and by FEV1/forced vital capacity (FVC) of 80% predicted or lower. Sensitivity and specificity of C-ACT scores for low FEV1 and FEV1/FVC levels were calculated. Logistic regression was used to obtain the area under the receiver operating characteristic curve (AUC) for C-ACT score categories by FEV1 level. RESULTS: Mean child age was 8.2 years, mean C-ACT score was 20.3 (SD = 3.96), mean FEV1 was 94.3% (SD = 17.1), and mean FEV1/FVC was 81.3 (SD = 8.5). Children with an FEV1 of 80% or less had significantly lower C-ACT scores than those with an FEV1 > 80% (p = .023, t = -2.015, df = 167); 95% CI [. -1.79 to -0.018]). The sensitivity and specificity of a C-ACT score of 19 or less for an FEV1 of 80% predicted or lower were 44.9 and 66.4%. With a C-ACT score of 22 or less, sensitivity and specificity for low FEV1 were 67.7 and 30.9%. The AUC for a C-ACT score of 19 or less and FEV1 of 80% or lower was .444 while the AUC was higher at .507 for a CACT score of 22 or less. CONCLUSION: The C-ACT is a useful screen but spirometry should be performed in children with persistent symptoms to assess current asthma control.

Effect of a school-based asthma clinic on asthma outcomes.

Background: The St. Louis Children's Hospital Healthy Kids Express Asthma (HKEA) program was developed to improve asthma control in children who attend schools with the highest asthma prevalence in the metropolitan area. The HKEA program differs from other programs because unscheduled visits occur at school without parents present. Objective: To assess the effectiveness of the HKEA program via a retrospective quality assurance study. Methods: A chart review was performed to evaluate the change in health-care utilization, absenteeism, staff and student education, inhaler technique checks, and parent satisfaction surveys before and after participation in the program. The Wilcoxon signed rank test, two-way analysis of variance, and descriptive statistics were used to analyze the data. Results: The HKEA program recruited 1076 participants ages 5-15 years during 3 school years, from 2008 to 2011. The participants showed a reduction in emergency department visits (36.9% to 14.2%) and hospitalizations (7.1% to 5.0%) from the year before beginning the program to the third year of the program. Absenteeism was significantly improved, from 59.1% to 27.1%. Staff and student knowledge of asthma improved significantly after completing asthma education programs. More than 90% of participants completed three technique checks of their inhaler and spacer technique and showed significant improvement in their tech check (an inhaler/aero chamber technique check) scores. Parent satisfaction with the HKEA program was rated excellent or very good by 96.9% of the parents. Conclusion: The HKEA program is a novel school-based asthma clinic that is well accepted by parents, and results in less health-care utilization and school absences as well as improved asthma knowledge in participants and the school staff.

Asthma control and obesity in urban African American children.

OBJECTIVE: To examine the relationship between body mass index (BMI), gender, age, controller medication use, household smoke exposure, season, and allergic rhinitis status with asthma control in a group of lower income, African American children. We hypothesized that non-obese children would have better asthma control. METHODS: Baseline data from a longitudinal study of children in a school-based asthma program in a Midwest urban area were analyzed. 360 children, ages 4-15 years, who were enrolled in either the 2012-2013 or 2013-2014 program were included. Asthma control was classified using criteria from the 2007 National Asthma Education and Prevention Program. Multiple ordinal regression was performed. RESULTS: The median age was 9 years, 61% had well-controlled asthma, and 29% were obese. The model included all main effects plus two interaction terms and was significant (χ2(7) = 22.17, p =.002). Females who were normal weight (OR, 2.78; 95% CI, 1.38-5.60, p =.004) or overweight (OR, 3.12; 95% CI, 1.26-7.72, p =.014) had better asthma control than obese females. For males, there were no differences by BMI category but males without allergic rhinitis had significantly better asthma control (OR, 2.23; 95% CI, 1.25-3.97, p =.006) than those with allergic rhinitis. CONCLUSIONS: Non-obese girls and non-allergic males had better asthma control. Promotion of healthy activity and nutrition as well as management of allergic rhinitis should be part of the asthma plan in school-based programs in low income urban areas. Innovative approaches to address asthma care in low income populations are essential.