Abstract:
BACKGROUND: Asthma is a worldwide problem. It cannot be prevented or cured, but it is possible,
at least in principle, to control asthma with modern management. Control usually is assessed by
history of symptoms, physical examination, and measurement of lung function. A practical problem
is that these measures of control may not be in agreement. The aim of this study was to
describe agreement among different measures of asthma control in children.
METHODS: A prospective sequential sample of children aged 4 to 11 years with atopic asthma
attending a routine follow-up evaluation were studied. Patients were assessed with the following
four steps: (1) fraction of exhaled nitric oxide (F ENO ), (2) spirometry, (3) Childhood Asthma Control
Test (cACT), and (4) conventional clinical assessment by a pediatrician. The outcome for each
test was coded as controlled or uncontrolled asthma. Agreement among measures was examined
by cross-tabulation and k statistics.
RESULTS: Eighty children were enrolled, and nine were excluded. Mean F ENO in pediatricianjudged
uncontrolled asthma was double that of controlled asthma (37 parts per billion vs
15 parts per billion, P , .005). There was disagreement among measures of control. Spirometric
indices revealed some correlation, but of the unrelated comparisons, those that agreed
with each other most often (69%) were clinical assessment by the pediatrician and the cACT.
Worst agreement was noted for F ENO and cACT (49.3%).
CONCLUSION: Overall, different measures to assess control of asthma showed a lack of agreement
for all comparisons in this study.
