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Marín D, Orozco LY, Narváez DM, Ortiz-Trujillo IC, Molina FJ, Ramos CD, Rodriguez-Villamizar L, Bangdiwala SI, Morales O, Cuellar M, Hernández LJ, Henao EA, Lopera V, Corredor A, Toro MV, Groot H, Villamil-Osorio M, Muñoz DA, Hincapié RC, Amaya F, Oviedo AI, López L, Morales-Betancourt R, Marín-Ochoa BE, Sánchez-García OE, Marín JS, Abad JM, Toro JC, Pinzón E, Builes JJ, Rueda ZV. Characterization of the external exposome and its contribution to the clinical respiratory and early biological effects in children: The PROMESA cohort study protocol. PLoS One 2023; 18:e0278836. [PMID: 36662732 PMCID: PMC9858469 DOI: 10.1371/journal.pone.0278836] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/01/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Air pollution contains a mixture of different pollutants from multiple sources. However, the interaction of these pollutants with other environmental exposures, as well as their harmful effects on children under five in tropical countries, is not well known. OBJECTIVE This study aims to characterize the external exposome (ambient and indoor exposures) and its contribution to clinical respiratory and early biological effects in children. MATERIALS AND METHODS A cohort study will be conducted on children under five (n = 500) with a one-year follow-up. Enrolled children will be followed monthly (phone call) and at months 6 and 12 (in person) post-enrolment with upper and lower Acute Respiratory Infections (ARI) examinations, asthma development, asthma control, and genotoxic damage. The asthma diagnosis will be pediatric pulmonologist-based and a standardized protocol will be used. Exposure, effect, and susceptibility biomarkers will be measured on buccal cells samples. For environmental exposures PM2.5 will be sampled, and questionnaires, geographic information, dispersion models and Land Use Regression models for PM2.5 and NO2 will be used. Different statistical methods that include Bayesian and machine learning techniques will be used for the ambient and indoor exposures-and outcomes. This study was approved by the ethics committee at Universidad Pontificia Bolivariana. EXPECTED STUDY OUTCOMES/FINDINGS To estimate i) The toxic effect of particulate matter transcending the approach based on pollutant concentration levels; ii) The risk of developing an upper and lower ARI, based on different exposure windows; iii) A baseline of early biological damage in children under five, and describe its progression after a one-year follow-up; and iv) How physical and chemical PM2.5 characteristics influence toxicity and children's health.
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Affiliation(s)
- Diana Marín
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Luz Yaneth Orozco
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
- School of Engineering, Universidad de Antioquia, Medellín, Colombia
| | | | | | | | | | - Laura Rodriguez-Villamizar
- Department of Public Health, School of Health, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Shrikant I. Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Statistics Department, Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Olga Morales
- School of Medicine, Pediaciencias Group, Universidad de Antioquia, Noel Clinic, Medellín, Colombia
- Department of Pediatrics, Hospital San Vicente Fundación, Medellín, Colombia
| | - Martha Cuellar
- School of Medicine, Pediaciencias Group, Universidad de Antioquia, Noel Clinic, Medellín, Colombia
- Department of Pediatrics, SOMER Clinic, Medellín, Colombia
| | | | | | - Verónica Lopera
- Secretaría de Salud, Alcaldía de Medellín, Medellín, Colombia
| | - Andrea Corredor
- Department of Pediatrics, ONIROS Centro Especializado en Medicina Integral del Sueño, Bogotá, Colombia
| | - María Victoria Toro
- School of Engineering, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Helena Groot
- Human Genetics Laboratory, Universidad de los Andes, Bogotá, Colombia
| | - Milena Villamil-Osorio
- Department of Pediatrics, Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
| | | | | | - Ferney Amaya
- School of Engineering, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Ana Isabel Oviedo
- School of Engineering, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lucelly López
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Beatriz Elena Marín-Ochoa
- School of Social Communications and Journalism, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | | | | | | | - Eliana Pinzón
- Secretaria distrital de Salud, Alcaldia de Bogota, Bogota, Colombia
| | | | - Zulma Vanessa Rueda
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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Zhang Y, Clegg JL, Keith S, McFadden S, Symonds T, Kumar R, Khan AH, Kamat S, Chao J. Content validity of a newly developed observer-reported measure for pediatric asthma in children aged 2-5 years. J Patient Rep Outcomes 2022; 6:55. [PMID: 35633412 PMCID: PMC9148329 DOI: 10.1186/s41687-022-00461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND An observer-reported outcome (ObsRO) measure assessing both symptom control and health-related quality of life (HRQoL) in children with asthma younger than 6 years is lacking. The objective of this study was to evaluate the content validity of the Pediatric Asthma Questionnaire (PAQ), a newly developed 6-item ObsRO measure for caregivers of children aged 2-5 years diagnosed with asthma. RESULTS In-depth, qualitative interviews were conducted with 15 parents or caregivers. The first part of the interview was an open-ended discussion whereby participants were asked to describe their observations of their child's asthma symptoms and HRQoL impacts followed by a cognitive debriefing of a draft version of the PAQ. The most frequently reported symptoms were coughing (n = 15, 100%), wheezing (n = 14, 93%), and trouble breathing (n = 10, 67%). Overall, participants found the PAQ easy to complete and relevant to their child's experience with asthma, with most reporting the instructions, response scales, and recall period for the items to be appropriate. The majority of participants (93%) believed they could accurately report on the items included in the PAQ based on their observations of their child's asthma symptoms and impacts, or reliably get the information from the child's teacher, school, or caregiver when their child was not in their presence. One item was modified based on feedback about the phrase "oral steroids" to clarify modes of administration. A few other minor changes were incorporated into the PAQ following suggestions from participants, including replacing the phrase "how often" with "how many days" in one of the items to improve clarity and overall consistency with the response options. CONCLUSION Qualitative data support the content validity of the PAQ as a fit-for-purpose and well-understood 6-item observer-reported outcome measure to evaluate both symptoms and asthma-specific HRQoL impacts experienced by pediatric asthma patients aged 2-5 years for use in clinical and real-world studies.
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Affiliation(s)
- Yi Zhang
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Jennifer L Clegg
- Clinical Outcomes Assessment, Clinical Outcomes Solutions, 53 W Jackson Blvd, Suite 1150, Chicago, IL, 60604, USA.
| | - Shannon Keith
- Clinical Outcomes Assessment, Clinical Outcomes Solutions, 53 W Jackson Blvd, Suite 1150, Chicago, IL, 60604, USA
| | - Shehan McFadden
- Clinical Outcomes Assessment, Clinical Outcomes Solutions, 53 W Jackson Blvd, Suite 1150, Chicago, IL, 60604, USA
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Liu L, Zhang J, Zhang L, Yuan SH, Wu JH, Tang MY, Chen JD, Zhang F, Qi XY, Yin Y. The Relationship of the Test for Respiratory and Asthma Control in Kids Initial Score on the Prognosis of Pre-school Children With Asthma: A Prospective Cohort Study. Front Pediatr 2021; 9:690333. [PMID: 34277524 PMCID: PMC8277926 DOI: 10.3389/fped.2021.690333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/03/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: The test for respiratory and asthma control in kids (TRACK) is currently the only standard follow-up tool for children under 5 years of age with asthma. The purpose of this study was to investigate the relationship between the TRACK initial score (Ti) and their prognosis after 6 months of follow-up in pre-schoolers with asthma. Design: A prospective cohort study. Methods: The study included pre-schoolers diagnosed with asthma at the Shanghai Children's Medical Center between January 2019 and June 2020, and follow-up for 6 months. TRACK scores, frequency of wheezing and respiratory infections, number of Emergency Department (ED) visits and treatment regimen were collected. According to the TRACK initial score, the children were divided into "Ti < 60 group" and "Ti ≥ 60 group," and the two groups were compared in terms of TRACK score related indicators, clinical manifestations and treatment. Results: There are 102 pre-schoolers included in the analysis [78 boys (76.5%) and 24 girls (23.5%); mean (SD) age, 28.05 (11.63) months]. After 6 months of follow-up, the TRACK score was improved in both groups, and the "Ti ≥ 60 group" had a higher score, lower rate of uncontrolled asthma and fewer reassessments were required. There was no difference in the number of wheezing attacks between the two groups in terms of clinical presentation, but the "Ti < 60 group" had more respiratory infections and ED visits. Regarding the use of ICSs, in the "Ti < 60 groups," the dose of ICSs was higher and reduced slowly, and the dose difference between the two groups began to appear after 5 months of follow-up. Conclusion: TRACK is essential for pre-schoolers with asthma at the time they are diagnosed. In addition, if the TRACK initial score is < 60, the probability of poor prognosis is higher.
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Affiliation(s)
- Lu Liu
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shu-Hua Yuan
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jin-Hong Wu
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming-Yu Tang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-De Chen
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fen Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin-Yi Qi
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Zhang J, Zhao L, Zhao D, Chen Z, Li S, Zhang H, Zhang L, Yuan S, Tang M, Wu Y, Zhong W, Xu J, Zhao LX, Liu SY, Hong J, Yin Y. Reliability and validity of the Chinese version of the Test for Respiratory and Asthma Control in Kids (TRACK) in preschool children with asthma: a prospective validation study. BMJ Open 2019; 9:e025378. [PMID: 31455696 PMCID: PMC6720147 DOI: 10.1136/bmjopen-2018-025378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The limited existing asthma control questionnaires that are available for children 5 years of age or younger in China mostly assess only the impairment domain of asthma control. Here, the English version of the Test for Respiratory and Asthma Control in Kids (TRACK) was translated into Chinese and validated for its application in asthma control in preschool children. DESIGN Prospective validation study. SETTING AND PARTICIPANTS A total of 321 Chinese preschool children suffering from asthma completed the study from December 2017 to February 2018. METHOD The TRACK translation into Chinese employed the translation and back translation technique. The caregivers of the preschool children with asthma symptoms completed TRACK during two clinical visits over 4-6 weeks. Moreover, the physicians completed a Global Initiative for Asthma (GINA)-based asthma control survey at both visits. The utility of TRACK for assessing the change in asthma control status and its reliability and discriminant validity were evaluated. RESULTS The Chinese version of TRACK showed internal consistency reliability values of 0.63 and 0.71 at each visit, respectively (Cronbach's α). The test-retest reliability was 0.62 for individuals whose GINA-based assessment results were the same at both visits (n=206). The TRACK scores for the children in the various asthma control categories were significantly different (p<0.001). Children recommended for increased treatment by the physicians had lower TRACK scores than those recommended for no change in treatment or decreased treatment (p<0.001). CONCLUSION The study verifies the validity and reliability of the Chinese version of TRACK. Changes in the TRACK scores effectively reflected the level of asthma control in preschool children and guided further treatment strategies. TRIAL REGISTRATION NUMBER NCT02649803.
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Affiliation(s)
- Jing Zhang
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liebin Zhao
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Deyu Zhao
- Respiratory Medicine, Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Zhimin Chen
- Respiratory Medicine, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Zhang
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Pediatrics, Shanghai Pudong District People's Hospital, Shanghai, China
| | - ShuHua Yuan
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mingyu Tang
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YuFen Wu
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenwei Zhong
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Juan Xu
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Xia Zhao
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shi Ying Liu
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianguo Hong
- Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yin
- Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Thapa G, Nair S, Oetjen C. Implementing an Evidence-Based, Asthma Decision Support Tool for Children Younger Than 5 Years Old. J Pediatr Health Care 2019; 33:296-308. [PMID: 30826137 DOI: 10.1016/j.pedhc.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Asthma is underdiagnosed, particularly for children younger than 5 years old. Clinical practice guidelines have been shown to improve asthma diagnosis and management, but are underutilized. This evidence-based practice project aimed to develop, implement, and evaluate a three-page decision support tool (DST) to improve the asthma diagnosis process among children younger than 5 years old. METHODS This project used a pre-experimental design and was conducted in a pediatric primary care setting with a predominantly South Asian population. The authors analyzed the utilization of the DST as well as the end-users' perception of the tool. RESULTS Despite above-average results in the end-users' usability scale, the DST had poor utilization. DISCUSSION Implementation of the DST is recommended at similar pediatric primary care sites. The EBP Project team recommends translating the DST to the electronic health record and improving the roles of the champion.
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Affiliation(s)
- Grace Thapa
- Grace Thapa, DNP Graduate, George Mason University, Fairfax, VA; and Family Nurse Practitioner, Burke Family Practice, Burke, VA
| | - Sharmila Nair
- Sharmila Nair, Pediatrician, Sterling Pediatrics, Sterling, VA
| | - Cheryl Oetjen
- Cheryl Oetjen, Assistant Professor and Assistant Dean for MSN and DNP Programs in the School of Nursing, George Mason University, School of Nursing, Fairfax, VA..
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Choi YJ, Jang GC, Yang HJ, Kim HB, Yoo Y, Shin M, Lee SY, Kim J, Kim WK, Suh DI, Koh YY. The Korean Version of the Test for Respiratory and Asthma Control in Kids (TRACK): Reliability and Validity. J Korean Med Sci 2019; 34:e25. [PMID: 30662389 PMCID: PMC6335117 DOI: 10.3346/jkms.2019.34.e25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/31/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Test for Respiratory and Asthma Control in Kids (TRACK) questionnaires were developed and validated in various languages to monitor respiratory control in preschool-aged children. We aimed to assess the reliability and validity of the Korean version of the TRACK questionnaire. METHODS We administered the linguistically validated TRACK questionnaires to caregivers of asthmatic preschool children on two separate visits 4-6 weeks apart. Each physician graded the level of the guideline-based asthma control, assessed the timing of symptoms, and adjusted the therapeutic level at each visit. RESULTS A total of 137 children were enrolled in the study. Cronbach's alpha was 0.65 for a questionnaire as a whole. The test-retest reliability was 0.72. The median TRACK scores were significantly different between asthma control status categories, with the lowest scores in children classified as poorly controlled and the highest in the well-controlled group (P < 0.001). They were different among groups classified according to the physician adjusted therapeutic levels, with the lowest values in children prescribed step-up therapy (P < 0.001), and according to the recency of respiratory symptoms (P < 0.001). Finally, the changes in TRACK scores between visits were highest in subjects showing improved control, followed by unchanged, and worsened control. When we applied the traditional cut-off of 80 for a well-controlled condition, a sensitivity of 75.6% and a specificity of 70.9% were calculated. CONCLUSION The Korean translated version of the TRACK questionnaire is valid and reliable to assess respiratory and asthma control in Korean preschool children with asthma symptoms.
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Affiliation(s)
- Yun Jung Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Sowha Children's Hospital, Seoul, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jakyoung Kim
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Yull Koh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Wandalsen GF, Dias RG, Chong-Neto HJ, Rosário N, Moraes L, Wandalsen NF, Medeiros D, Bianca ACD, Urrutia-Pereira M, Avila J, Jorge PP, Solé D. Test for Respiratory and Asthma Control in Kids (TRACK): validation of the Portuguese version. World Allergy Organ J 2018; 11:40. [PMID: 30534341 PMCID: PMC6282290 DOI: 10.1186/s40413-018-0219-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 10/22/2018] [Indexed: 11/11/2022] Open
Abstract
Background TRACK (Test for Respiratory and Asthma Control in Kids) questionnaire is an instrument developed and validated in English to evaluate the control of respiratory symptoms in children under 5 years of age. Objective To validate the Portuguese version of the TRACK questionnaire. Methods The validation was done in an observational, prospective and multicenter evaluation (six centers in Brazil) in children with recurrent respiratory symptoms. Children were classified according to symptoms, GINA criteria and medical evaluation. Parents and doctors rated child respiratory symptom control in the last month (VAS). Approval from the Institutional Review Board was obtained in each centre, and written informed consent was obtained from parents. Results Data from 299 children were obtained at baseline, and 195 at follow-up. The median score of the TRACK questionnaire was 65 and Cronbach’s α was 0.70. TRACK scores showed significant correlation with the medical and family opinions about symptom control (r: 0.74 and r: 0.61). TRACK scores were significantly lower in children who had used systemic steroids (median [IQR]: 45 [30–65] vs 75 [55–80]; p < 0.001) and had an emergency visit in the last month (45 [35–60] vs 70 [55–80]; p < 0.001). TRACK scores were also significantly different when children were separated by the medical opinion, GINA criteria and symptoms. Comparison of different respiratory symptom control cut-off points showed that the cut-off of 80 points had the highest area under ROC curve (0.800). Conclusion We have demonstrated that the Portuguese version of the TRACK questionnaire has satisfactory reliability (internal consistency), adequate criterion validity (compared against GINA levels of control) and constructive validity (compared against respiratory symptoms and medical opinion), showing that it can be a useful tool to discriminate among children with different levels of respiratory symptom control. Trial registration ClinicalTrials.gov: NCT03290222.
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Affiliation(s)
- Gustavo F Wandalsen
- 1Federal University of São Paulo (UNIFESP), Rua dos Otonis 725, São Paulo, SP 04025-002 Brazil
| | - Renata G Dias
- 1Federal University of São Paulo (UNIFESP), Rua dos Otonis 725, São Paulo, SP 04025-002 Brazil
| | | | | | - Lillian Moraes
- 3Federal University of Mato Grosso (UFMT), Cuiabá, Brazil
| | | | - Décio Medeiros
- 5Federal University of Pernambuco (UFPE), Recife, Brazil
| | | | | | | | | | - Dirceu Solé
- 1Federal University of São Paulo (UNIFESP), Rua dos Otonis 725, São Paulo, SP 04025-002 Brazil
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Asthma control in preschool children with small airway function as measured by IOS and fractional exhaled nitric oxide. Respir Med 2018; 145:8-13. [PMID: 30509720 DOI: 10.1016/j.rmed.2018.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/04/2018] [Accepted: 10/10/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study investigated the accuracy of impulse oscillometry (IOS) combined with fractional exhaled nitric oxide (FeNO) to assess asthma control among preschool children. METHODS A total of 79 preschool children(3-6 year old) with asthma and 25 healthy preschool children who visited a paediatrician were enrolled in this study. All of the children were tested for allergens, respiratory system resistance (at 5 and 20 Hz [R5, R20]), respiratory system reactance (at 5 Hz [X5]), the resonant frequency of reactance (Fres), and the area under the reactance curve (between 5 Hz and Fres (reactance area [AX]) using IOS and FeNO. A paediatric respiratory specialist who was unaware of the IOS and FeNO results assigned children with asthma to either the asthma-controlled group (n = 27) or the asthma-uncontrolled group (n = 52) based on the Global Initiative for Asthma (GINA) criteria. A healthy control group (n = 25) was also included. The relationships between the FeNO and IOS values as well as the asthma control of the three groups were analysed, and the areas under the curve (AUCs) were calculated for each measure. RESULTS (1) During the controlled group, means±standard deviations of AX, R5-20, R5, X5 and FeNO were 26.15 ± 7.534, 3.52 ± 1.311,9.97 ± 1.576,-3.85 ± 0.572,-3.85 ± 0.572. During the uncontrolled group, means±standard deviations of AX,R5-20,R5,X5 and FeNO were 38.34 ± 13.563,5.36 ± 1.545,11.41 ± 2.029,-5.07 ± 1.554,36.40 ± 21.07. Among preschool children, significant differences were observed between the controlled and uncontrolled group with regard to the small airway functional parameters (AX, R5-20, R5, and X5) and FeNO(P <0.05).(2) A receiver operating characteristic (ROC) analysis showed that the AUCs were 0.786 for FeNO alone, 0.751 for X5 alone, and 0.866 for X5 combined with FeNO (cut-off value: 27 ppb). CONCLUSION FeNO combined with the small airway function parameter X5 accurately assessed asthma control among preschool children.
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Sato K, Sato Y, Nagao M, Shimojo N, Yoshihara S, Adachi Y, Kameda M, Terada A, Fujisawa T. Development and validation of asthma questionnaire for assessing and achieving best control in preschool-age children. Pediatr Allergy Immunol 2016; 27:307-12. [PMID: 26659837 DOI: 10.1111/pai.12523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Several patient-/caregiver-completed questionnaires have been utilized for the assessment of asthma control. However, due to the diversity in medical/social circumstances, they may not be optimal for use in all countries. The Japanese pediatric asthma guideline (JPGL) aims at higher levels of control compared with other international guidelines, based on a strong social demand for best care. We developed a new control test to help meet that demand. METHODS A 34-item working questionnaire was developed based on input from pediatric asthma specialists and the caregivers of preschool children with asthma. The questionnaire was administered to caregivers of 565 patients aged <6 years who had physician-diagnosed asthma or β2-agonist-responsive recurrent wheeze. Then, 6 questions for assessing JPGL-defined control levels were selected from the 34 questions by stepwise logistic regression methods using randomly selected questionnaires completed by two-thirds of the caregivers. We named that set of questions the Best Asthma Control Test for Preschoolers (Best ACT-P). Validation of Best ACT-P was performed using the remaining completed questionnaires. RESULTS The 6 questions asked about the frequency/severity of cold-induced wheeze, nighttime awakening, exercise-induced symptoms, and disruption of family life due to asthma in the past 4 weeks and hospitalization in the past 12 months. The 6-item logistic model showed good statistical fit, and the scores for the physicians' ratings of the asthma control differed significantly in the hypothetical direction. CONCLUSIONS Best ACT-P is a valid caregiver-completed questionnaire of asthma control in preschoolers in whom total control needs to be achieved.
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Affiliation(s)
- Kazuki Sato
- Department of Pediatrics, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Yasunori Sato
- Clinical Research Center, Chiba University, Chiba, Japan
| | - Mizuho Nagao
- Allergy Center, Mie National Hospital, Tsu, Japan
| | - Naoki Shimojo
- Department of Pediatrics, University of Chiba Graduate School of Medicine, Chiba, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, Utsunomiya, Japan
| | - Yuichi Adachi
- Department of Pediatrics, Toyama University Graduate School of Medicine, Toyama, Japan
| | - Makoto Kameda
- Department of Pediatrics, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
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Oh HL, Koh YY, Suh DI, Kang BC, Kim BS, Kim WK, Kim J, Kim JT, Kim HB, Park G, Baek H, Song DJ, Shin MY, Yang HJ, Woo SI, Yoo Y, Yu J, Lee SY, Lim DH. Translation and linguistic validation of Korean version of the Test for Respiratory and Asthma Control in Kids instrument. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.1.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hea Lin Oh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Yull Koh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | | | - Bong-Seong Kim
- Department of Pediatrics, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jakyoung Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jin Tack Kim
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Geunhwa Park
- Department of Pediatrics, Gwanghye General Hospital, Busan, Korea
| | - Heysung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Mee Yong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung-Il Woo
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
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11
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Forno E, Gogna M, Cepeda A, Yañez A, Solé D, Cooper P, Avila L, Soto-Quiros M, Castro-Rodriguez JA, Celedón JC. Asthma in Latin America. Thorax 2015; 70:898-905. [PMID: 26103996 DOI: 10.1136/thoraxjnl-2015-207199] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/02/2015] [Indexed: 12/20/2022]
Abstract
Consistent with the diversity of Latin America, there is profound variability in asthma burden among and within countries in this region. Regional variation in asthma prevalence is likely multifactorial and due to genetics, perinatal exposures, diet, obesity, tobacco use, indoor and outdoor pollutants, psychosocial stress and microbial or parasitic infections. Similarly, non-uniform progress in asthma management leads to regional variability in disease morbidity. Future studies of distinct asthma phenotypes should follow-up well-characterised Latin American subgroups and examine risk factors that are unique or common in Latin America (eg, stress and violence, parasitic infections and use of biomass fuels for cooking). Because most Latin American countries share the same barriers to asthma management, concerted and multifaceted public health and research efforts are needed, including approaches to curtail tobacco use, campaigns to improve asthma treatment, broadening access to care and clinical trials of non-pharmacological interventions (eg, replacing biomass fuels with gas or electric stoves).
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Affiliation(s)
- Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mudita Gogna
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alfonso Cepeda
- Fundación Hospital Universitario Metropolitano, Laboratorio de Alergia e Inmunología, Universidad Metropolitana, Barranquilla, Barranquilla, Colombia
| | - Anahi Yañez
- Division of Allergy and Immunology, Servicio de Alergia e Inmunología Clínica, Hospital Aeronáutico Central, Buenos Aires, Argentina
| | - Dirceu Solé
- Escola Paulista de Medicina, São Paulo, Brazil
| | - Philip Cooper
- Laboratorio de Investigaciones FEPIS, Quinindé, Esmeraldas, Ecuador Institute of Infection and Immunity, St George's University of London, London, UK
| | | | | | - Jose A Castro-Rodriguez
- Departments of Pediatrics and Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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Szefler SJ. Advances in pediatric asthma in 2014: Moving toward a population health perspective. J Allergy Clin Immunol 2015; 135:644-52. [PMID: 25649079 DOI: 10.1016/j.jaci.2014.12.1921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/29/2014] [Accepted: 12/29/2014] [Indexed: 01/30/2023]
Abstract
Last year's "Advances in pediatric asthma in 2013: Coordinating asthma care" concluded that, "Enhanced communication systems will be necessary among parents, clinicians, health care providers and the pharmaceutical industry so that we continue the pathway of understanding the disease and developing new treatments that address the unmet needs of patients who are at risk for severe consequences of unchecked disease persistence or progression." This year's summary will focus on further advances in pediatric asthma related to prenatal and postnatal factors altering the natural history of asthma, assessment of asthma control, and new insights regarding the management of asthma in children as indicated in Journal of Allergy and Clinical Immunology publications in 2014. A major theme of this review is how new research reports can be integrated into medical communication in a population health perspective to assist clinicians in asthma management. The asthma specialist is in a unique position to convey important messages to the medical community related to factors that influence the course of asthma, methods to assess and communicate levels of control, and new targets for intervention, as well as new immunomodulators. By enhancing communication among patients, parents, primary care physicians, and specialists within provider systems, the asthma specialist can provide timely information that can help to reduce asthma morbidity and mortality.
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Affiliation(s)
- Stanley J Szefler
- Pediatric Asthma Research Program, Section of Pediatric Pulmonary Medicine, Breathing Institute, Department of Pediatrics, Children's Hospital Colorado, and the Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colo.
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