Assessment Of Asthma Control Research Articles

Validation of asthma control questionnaire and risk factors affecting uncontrolled asthma among the Lebanese children's population

ObjectivesTo validate the Arabic version of the Asthma Control Test (ACT) in asthmatic children in Lebanon and identify risk factors that might affect asthma control in these children. MethodsThis study, conducted between December 2015 and April 2016, included 300 children. ResultsA high Cronbach's alpha was found for the full scale (0.959). The correlation factors between each item of the ACT scale and the whole scale ranged between 0.710 and 0.775(p < 0.001 for all items). Low mother's educational level as well as the history of asthma in the mother and the father would significantly increase the risk of uncontrolled asthma (p = 0.001; Beta = 1.862; p < 0.001; Beta = 3.534; p < 0.001; Beta = 1.885respectively). Cigarette smoking during breastfeeding and waterpipe smoking by the mother during pregnancy were both significantly associated with uncontrolled asthma (p = 0.005; Beta = 2.105 and p = 0.041; Beta = 2.325 respectively). The high mother's level of education was significantly associated with more asthma control (p = 0.008; Beta = −0.715). ConclusionThe Arabic version of the asthma control questionnaire is a valid tool to use in pediatric patients in the Lebanese population to assess asthma control. Waterpipe smoking during pregnancy and cigarette smoking during breastfeeding, as well as the lower education level are risk factors for uncontrolled asthma. Spreading awareness among health care professionals, as well as reinforcing health education seem to be an important step toward a better asthma control.

Consistency of maternal telephone administration of the asthma control test using postpartum recall compared to repeated measures during pregnancy

ABSTRACTBackground: Suboptimal asthma control during pregnancy may impact perinatal outcomes. U.S. guidelines recommend questionnaires to assess asthma control including the Asthma Control Test (ACT). It is unknown in a research setting to what extent recall differs by the time between symptom occurrence and the administration of the questionnaire. Methods: Between 2009–2014, 196 pregnant asthmatic women were recruited by the Organization of Teratology Information Specialists (OTIS) MotherToBaby Pregnancy Studies. Participants were administered the ACT at enrollment, gestational weeks 20 and 32, and shortly after delivery. The same women were also administered the ACT retrospectively at approximately 6 months postpartum. Results: The Pearson correlation coefficients between the in-pregnancy and retrospective continuous ACT scores for the 1st, 2nd and 3rd trimesters were: 0.67 (95% CI: 0.58, 0.74), 0.61 (0.52, 0.70) and 0.65 (0.56, 0.72), respectively. When dichotomized into well-controlled asthma (ACT score ≥ 20) versus otherwise, the chi-square test for all three trimesters resulted in p values <0.0001. Cohen's Kappa statistics for the same dichotomized scores were 0.51, 0.45 and 0.40 for each trimester respectively. There was no evidence that adverse outcome of pregnancy (recall bias) influenced postpartum responses. Conclusions: The retrospectively recalled ACT score obtained postpartum was substantially different compared to in-pregnancy administration of the same questionnaire which could reflect test-retest variability as well as attenuation of recall. Documentation of the magnitude and direction of these differences could be useful in interpretation of the impact of asthma control when the ACT is used in retrospective case-control studies for pregnancy outcomes.

Assessment of work-related asthma prevalence, control and severity: protocol of a field study.

BackgroundThere are still uncertainties regarding the respective prevalence, diagnosis and management of occupational asthma (OA) and work-exacerbated asthma (WEA). There is as yet no standardized methodology to differentiate their diagnosis. A proper management of both OA and WEA requires tools for a good phenotyping in terms of control, severity and quality of life in order to propose case-specific therapeutical and preventive measures. Moreover, there is a lack of knowledge concerning their actual costs.MethodsThis project aims at comparing 3 groups of asthmatic subjects at work: subjects with OA, with WEA, and with non-work-related asthma (NWRA) in terms of control, severity and quality of life on the one hand, and estimating the prevalence of OA, WEA and NWRA in active workers and the economic costs of OA and WEA, on the other hand. Control will be assessed using the Asthma Control Test questionnaire and the daily Peak Exploratory Flow variability, severity from the treatment level, and quality of life using the Asthma Quality of Life Questionnaire. A first step will be to apply a standardized diagnosis procedure of WEA and OA. This study includes an epidemiological part in occupational health services by volunteering occupational physicians, and a clinical case-study based on potentially asthmatic subjects referred to ten participating University Hospital Occupational Diseases Departments (UHODD) because of a suspected WRA. The subjects’ characterization with respect to OA and WEA is organized in three steps. In Step 1 (epidemiological part), occupational physicians screen for potentially actively asthmatics through a questionnaire given to workers seen in mandatory medical visit. In step 2 (both parts), the subjects with a suspicion of work-related respiratory symptoms answer a detailed questionnaire and perform a two-week OASYS protocol enabling us, using a specifically developed algorithm, to classify them into probably NWRA, suspected OA, suspected WEA. The two latter groups are referred to UHODD for a final harmonized diagnosis (step 3). Finally, direct and indirect disease-related costs during the year preceding the diagnosis will be explored among WRA cases, as well as these costs and the intangible costs, during the year following the diagnosis.DiscussionThis project is an attempt to obtain a global picture of occupational asthma in France thanks to a multidisciplinary approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3824-0) contains supplementary material, which is available to authorized users.

P135 Use of a novel passive heart rate monitoring device to assess asthma control

Early recognition of asthma exacerbations decreases disease severity and reduces hospital admissions. Changes in heart rate (HR) may represent a sensitive marker of onset and resolution of asthma exacerbations. The present work addresses this notion with three separate but interrelated components.

PRS54 - Patient Reported Asthma Control In Comparison To Physician Assessed Asthma Control: A Cross-Sectional Analysis of The Act Questionnaire Based on 673 Asthma Patients

PRS54 - Patient Reported Asthma Control In Comparison To Physician Assessed Asthma Control: A Cross-Sectional Analysis of The Act Questionnaire Based on 673 Asthma Patients

Determinants of longitudinal health-related quality-of-life change in children with asthma from low-income families: a report from the PROMIS® Pediatric Asthma Study.

How the longitudinal asthma control status and other socio-demographic factors influence the changes of health-related quality of life (HRQOL) among asthmatic children, especially from low-income families, has not been fully investigated. This study aimed to describe the trajectories of asthma-specific HRQOL over 15 months and examine the effect of asthma control status on HRQOL by taking socio-demographic factors into consideration. A total of 229 dyads of asthmatic children and their parents enroled in public insurance programs were recruited for assessing asthma control status and HRQOL over four time points of assessment. Asthma control status was measured using the Asthma Control and Communication Instrument, and asthma-specific HRQOL was assessed using the Patient-Reported Outcomes Measurement Information System's Pediatric Asthma Impact Scale. Latent growth models (LGMs) were applied to examine the trajectory of HRQOL and the factors contributing to the changes of HRQOL. Unconditional LGM revealed that HRQOL was improved over time. Conditional LGM suggested that accounting for asthma control and participants' socio-demographic factors, the variation in the initial level of HRQOL was significant, yet the rate of change was not. Conditional LGM also revealed that poorly controlled asthma status was associated with poor HRQOL at each time point (P's < 0.05). Lower parental education was associated with lower baseline HRQOL (P < 0.05). Hispanic children had a larger increase in HRQOL over time (P < 0.01) than non-Hispanic White children. Vulnerable socio-demographic characteristics and poorly controlled asthma status affect HRQOL in children. This finding encourages interventions to improve asthma control status and HRQOL in minority children.

Measurement characteristics of the childhood Asthma-Control Test and a shortened, child-only version.

The childhood Asthma-Control Test (C-ACT) is validated for assessing asthma control in paediatric asthma. Among children aged 4–11 years, the C-ACT requires the simultaneous presence of both parent and child. There is an unmet need for a tool that can be used to assess asthma control in children when parents or caregivers are not present such as in the school setting. We assessed the psychometric properties and estimated the minimally important difference (MID) of the C-ACT and a modified version, comprising only the child responses (C-ACTc). Asthma patients aged 6–11 years (n=161) from a previously completed multicenter randomised trial were included. Demographic information, spirometry and questionnaire scores were obtained at baseline and during follow-up. Participants or their guardians kept a daily asthma diary. Internal consistency reliabilities of the C-ACT and C-ACTc were 0.76 and 0.67 (Cronbach’s α), respectively. Test–retest reliabilities of the C-ACT and C-ACTc were 0.72 and 0.66 (intra-class correlation), respectively. Significant correlations were noted between C-ACT scores and ACQ scores (Spearman’s correlation r=−0.56, 95% CI (−0.66, −0.44), P<0.001). The strength of the correlation between C-ACTc scores and ACQ scores was weaker (Spearman’s correlation r=−0.46, 95% CI (−0.58, −0.33), P<0.001). We estimated the MID for the C-ACT and C-ACTc to be 2 points and 1 point, respectively. Among asthma patients aged 6–11 years, the C-ACT had good psychometric properties. The psychometric properties of a shortened child-only version (C-ACTc), although acceptable, are not as strong.

Acculturation and quality of life in urban, African American caregivers of children with asthma

Objective: Racial/ethnic minority caregivers of children with asthma are at risk for low levels of quality of life (QOL). Limited research has identified factors that contribute to lower QOL among African American caregivers. This study examined associations between acculturation (e.g., engaging in values/beliefs traditional of one's culture versus adopting mainstream cultural views) and caregiver QOL in low-income, urban African American families of children (7–12 years) with persistent asthma. We also investigated the association between caregiver QOL and child emergency department (ED) use. Methods: Fifty-five caregivers and their children completed interview-based questionnaires in a single research session. Caregivers completed the Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ), the African American Acculturation Scale-Revised (AAAS-R), and reported on child asthma variables. Children completed items assessing asthma control. Results: Higher overall QOL and emotional function subscale scores were associated with more traditional African American religious beliefs/practices (r = .288, p = .033; r = .333, p = .013). Higher emotional function subscale scores were associated with more traditional values of African American families (r = .306, p = .023). Lower QOL was found among caregivers of children who had visited the ED three or more times in the last year. Conclusions: Less acculturation tied to religious beliefs/practices and family values (as measured by the AAAS-R) may serve a protective role in reducing the burden low-income, urban African American caregivers experience in managing child asthma. This study is the first of its kind to study acculturation in African American caregivers of children with asthma.

Stepping down from combination asthma therapy: The predictors of outcome

BackgroundStepping down from combination asthma therapy (inhaled corticosteroids (ICS) + long-acting β2 agonists (LABA)) is often avoided due to fear of exacerbations, which may lead to overmedication in well-controlled asthma. A better knowledge about the predictors of outcome might encourage clinicians to start stepping down more often than previously. MethodsIn 55 subjects with well controlled asthma and combination therapy, LABAs were discontinued first, followed by ICS dose halving, and then cessation, in six weeks’ intervals. The ability of Juniper’s asthma control questionnaire (ACQ), ambulatory peak flow monitoring, spirometry, and hypertonic saline challenge to predict the outcomes of medication reductions were assessed. ResultsThe proportions of subjects experiencing an exacerbation at each step were: 4 out of 55 subjects (7%) after LABA cessation, 4 out of 25 subjects (16%) after ICS dose halving, and 21 out of 46 subjects (46%) after ICS cessation. All exacerbations could be managed on an outpatient basis. There were 126 step-downs altogether. ACQ score < 0.29 (likelihood ratio 2.30 (1.05–5.05)), ACQ without spirometry < 0.15 (2.17 (0.96–4.90)) and FEV1 > 96% of predicted (2.18 (1.03–4.61)) predicted a successful outcome after step-down. Cough responsiveness to saline, bronchoconstrictive responsiveness to saline, and peak flow variation were not associated with the outcome. ConclusionCombination therapy can often be reduced in controlled asthma but total cessation of ICSs must be carefully considered. Simple investigations, namely asthma control assessment by validated questionnaire and spirometry, help to predict the outcome of stepping down. Trial registryThe study was registered in ClinicalTrials.gov database (https://clinicaltrials.gov, KUH5801124).

Is There an App for That? Assessing the Quality and Content of Apps for Asthma Management Available In Canada

Abstract BACKGROUND: Asthma is the most common chronic respiratory disease in Canada, with highest prevalence in children 5-17 years of age. The use of effective apps for asthma management for children and adolescents may decrease the significant morbidity of this disease. A wide range of apps designed to assist in the home management of asthma are available online. However, there are no published data assessing the quality and content of asthma apps for children and families in Canada. OBJECTIVES: To evaluate apps targeted at children or parents for the active management of asthma based on quality, accuracy of content and presence of advertising. DESIGN/METHODS: The iOS and Google Play stores were searched using the key terms “asthma”, “reactive airways”, “puffer”, and “wheeze”. Apps that were available in English or French, were interactive, were targeted at children or their families, and addressed the medical management of asthma were included. Apps were examined using a detailed data collection tool to assess usability and content. Quality criteria was based on a published, validated tool. Content was evaluated based on the Canadian Thoracic Society asthma guidelines. RESULTS: A total of 95 apps were screened, and 11 met the inclusion criteria. Average app quality score was 3.65 (range 2.63 – 4.38) out of 5. One app used 7 out of 7 CTS criteria in assessing asthma control, one used 6, six used 5, and three used 4. 10 out of 11 apps had the capacity to track symptoms, which was linked to level of asthma control based on CTS/CPS criteria. 8 out of 11 apps had the capacity to record medication doses in a journal format and provided daily medication reminders. 6 apps had the capacity to create and save a personalized asthma action plan. All apps used medications available in Canada. The most functional app based on these criteria was asthmamd, followed by AsthmaSense. One app was funded but a pharmaceutical company and had industry logo, but no significant brand bias. No other apps had specific industry advertising. None were specifically designed for use by children or adolescents. CONCLUSION: 11 relatively high-quality apps are available for asthma management for Canadian families. Of these apps, the ones that best match quality, adherence to CTS guidelines, and lack of marketing/branding are asthmamd and AsthmaSense. There exists a gap to create apps that are specifically targeted at children and adolescents with high functionality for managing asthma.

Pediatric asthma medication therapy management through community pharmacy and primary care collaboration

ObjectivesTo design and implement a collaborative medication therapy management (MTM) program targeting pediatric patients with high-risk asthma in a community pharmacy. SettingUnderserved inner city of Cincinnati, OH. Practice descriptionA large national grocery store chain pharmacy and an academic hospital developed a partnership aimed at improving asthma care for shared patients. An interdisciplinary project team was formed, including 2 clinical pharmacists, 1 pharmacy district clinical coordinator, 1 pharmacy division clinical coordinator, 1 associate professor at a college of pharmacy, 1 pharmacy resident, and 3 pediatric physicians. This pilot project involved 2 Kroger Pharmacy sites and Cincinnati Children's Hospital Medical Center's (CCHMC) 3 pediatric primary care centers. Practice innovationKroger and CCHMC staff identified shared high-risk asthma patients (those cared for at the included primary care centers who used Kroger for their medication fills) with the use of information from validated symptom assessments (Asthma Control Test), refill history, and recent health care utilization. Community pharmacists recruited jointly identified patients and provided a targeted MTM intervention. Education focused on asthma diagnosis, types of asthma medications, appropriate medication administration, and environmental triggers. Pharmacists suggested medication changes to prescribers via facsimile. Pharmacists followed up with patients in 30 days to assess asthma control, provide additional education, and propose further recommendations. EvaluationOutcomes evaluated included the average number of recommendations made to patients and prescribers and acceptance rates for each of those measures. ResultsSix patients completed the project. Pharmacists provided an average of 3.7 recommendations to each patient and 1.5 to prescribers for each patient; 77.3% and 100% recommendations were accepted, respectively. ConclusionThis pilot project describes the design and implementation of a pharmacist-physician collaborative program for high-risk pediatric asthma patients. The greatest outcome of this project was the formation of a collaborative team between pharmacists and physicians that continues to work together on additional family-centered initiatives.

Asthma control and need for future asthma controller therapy among inner-city Hispanic asthmatic children engaged in a pediatric asthma disease management program (the Breathmobile program, Mobile Asthma Care for Kids Network)

Objective: To determine whether significant numbers of asthmatic children with initially rated intermittent asthma later suffer poor asthma control and require the addition of controller medications. Methods: Inner-city Hispanic children were followed prospectively in an asthma-specific disease management system (Breathmobile) for a period of 2 years. Clinical asthma symptoms, morbidity treatment, and demographic data were collected at each visit. Treatment was based upon National Heart, Lung, and Blood Institute (NHLBI) Expert Panel Report 3 asthma guidelines. Primary outcome was percentage of patients with intermittent asthma who had not well or poorly controlled asthma during subsequent visits and required controller agents. Secondary outcomes were factors associated with the maintenance of asthma control. Results: About 30.9% of the patients with initial rating of intermittent asthma had not well controlled and poorly controlled asthma during subsequent visits and required the addition of controller agents. Factors associated with good asthma control were compliance, no previous emergency room visits and previous visit during spring season. Conclusion: Asthmatic children with intermittent asthma often lose asthma control and require controller therapy. This justifies asthma guideline recommendations to assess asthma control at follow-up visits and adjust therapy accordingly.

Asthma in pregnancy: association between the Asthma Control Test and the Global Initiative for Asthma classification and comparisons with spirometry

ObjectiveThe aim of this study was to identify a possible association between the assessment of clinical asthma control using the Asthma Control Test (ACT) and the Global Initiative for Asthma (GINA) classification and to perform comparisons with values of spirometry. Study designThrough this cross-sectional study, 103 pregnant women with asthma were assessed in the period from October 2010 to October 2013 in the asthma pregnancy clinic at the Clinical Hospital of the Federal University of Pernambuco. Questionnaires concerning the level of asthma control were administered using the Global Initiative for Asthma classification, the Asthma Control Test validated for asthmatic expectant mothers and spirometry; all three methods of assessing asthma control were performed during the same visit between the twenty-first and twenty-seventh weeks of pregnancy. ResultsThere was a significant association between clinical asthma control assessment using the Asthma Control Test and the Global Initiative for Asthma classification (p<0.001). There were also significant associations between the results of the subjective instruments of asthma (the GINA classification and the ACT) and evidence of lung function by spirometry. ConclusionsThis study shows that both the Global Initiative for Asthma classification and the Asthma Control Test can be used for asthmatic expectant mothers to assess the clinical control of asthma, especially at the end of the second trimester, which is assumed to be the period of worsening asthma exacerbations during pregnancy. We highlight the importance of the Asthma Control Test as a subjective instrument with easy application, easy interpretation and good reproducibility that does not require spirometry to assess the level of asthma control and can be used in the primary care of asthmatic expectant mothers.

Uncontrolled asthma and its risk factors in Chinese children: A cross-sectional observational study

Objective: Asthma afflicts many children in China but information about asthma management among Chinese pediatric asthma patients is limited. This study aims to evaluate asthma control among Chinese pediatric patients and identify risk factors associated with uncontrolled asthma. Methods: A total of 4223 patients with persistent asthma aged 2–16 years from 42 tertiary hospitals across all regions of mainland China except Tibet were surveyed. Asthma Control Test (ACT), Childhood Asthma Control Test (C-ACT) and Global Initiative for Asthma (GINA) criteria were used to assess asthma control for children aged 12–16 years, 4–11 years and 2–3 years, respectively. Uncontrolled asthma was defined as ACT or C-ACT score ≤19 or GINA-defined uncontrolled asthma. Risk factors associated with uncontrolled asthma were identified using multivariate logistic regression models. Results: Asthma was uncontrolled in 19.9% of the subjects. High rates of uncontrolled asthma were found in subjects with treatment non-adherence (44.1%), concomitant allergic rhinitis (AR) (23.3%), disease duration ≥ 1.5 years (22.8%), and first-degree relatives with AR (21.5%). The risk of uncontrolled asthma was much higher in the treatment non-adherence group compared to the complete adherence group (OR = 5.79, p < 0.001). Concomitant AR, disease duration ≥ 1.5 years, and first-degree relatives with AR were also confirmed as risk factors associated with uncontrolled asthma. Conclusions: About 20% of Chinese pediatric asthma patients had uncontrolled asthma. Treatment adherence and AR were the most significant risk factors. Tailored measures aimed at improving treatment adherence and diagnosis and treatment of AR should be adopted to improve the level of asthma control in Chinese children.

Sputum interleukin‐13 as a biomarker for the evaluation of asthma control

Asthma control refers to the extent to which the manifestations of asthma have been reduced or eradicated by treatment. Interleukin-13 (IL-13) has a central role in Th2 response and serves as a possible therapeutic target in uncontrolled asthma. Fraction of exhaled nitric oxide (FeNO) and sputum eosinophils have modest performance in the evaluation of asthma control. To assess the diagnostic performance of sputum IL-13 for the evaluation of asthma control and furthermore to investigate the performance of sputum eosinophils and FeNO. One hundred and seventy patients with asthma were studied. All subjects underwent assessment of asthma control by asthma control test (ACT), lung function tests, FeNO measurement and sputum induction for cell count identification and IL-13 measurement in supernatants. IL-13 (pg/mL) levels in sputum supernatant differed significantly among patients with well-controlled asthma and those with not well-controlled asthma [median IQR 78 (66-102) vs. 213 (180-265), P < 0.001]. Receiver operating characteristic (ROC) analysis showed that, for the whole study population, the diagnostic performance of IL-13 was superior to both sputum eosinophils and FeNO levels [area under the curve (AUC) 0.92, 95% CI 0.87 to 0.95 vs. AUC 0.65, 95% CI 0.58 to 0.72 vs. AUC 0.65, 95% CI 0.55 to 0.72, respectively]. The diagnostic performance of sputum IL-13 was superior to both sputum eosinophils and FeNO levels for the identification of well-controlled asthma. Sputum IL-13 levels could serve as a useful biomarker for asthma control assessment.

Comprehensive risk factors, asthma control, and life quality pathways in adults with asthma: A structural equation modeling analysis.

Previous studies reported that environmental factors, particularly the work environment, were related to quality of life (QoL) in patients with asthma. However, the pathway that links workplace and QoL in adults with asthma is still not clear. The aim of this study was to explore the comprehensive environmental factors, asthma control, and QoL pathways in patients with asthma. Two cohorts of patients with asthma were established, including a prospective phase cohort in 2006 and a cross-sectional phase cohort in 2012. The Asthma Control Test was used to determine the level of disease control, and QoL was assessed by using the Taiwanese version of an asthma quality-of-life questionnaire. In 2014, a structural equation model was applied to explore the pathways from the risk factors to QoL. The structural equation model for predicting QoL provided a good fit (χ(2) [degrees of freedom] = 43.81 [38]; root mean square error of approximation 0.021 [90% confidence interval, 0.001-0.044]) after combining the two cohorts. The wheeze frequency, allergic response frequency, parental asthma, and asthma control were directly associated with QoL. We found that patients who were obese and who worked in poor environments had increased work symptoms and wheeze frequency during the previous year in a cross-sectional phase cohort. However, we did not find that body mass index was a significant factor in a prospective cohort. The patients with obesity and with frequent work symptoms, which induced poor asthma control, were possible mechanisms in the pathway from workplace exposure to poor QoL in the observed adults with asthma in our combined data. Body mass index, the work environment, and the wheeze frequency should be considered when assessing asthma control and QoL in adult patients with asthma. Patients who reduce their body weight or avoid exposure to poor workplaces may find this useful for their asthma control and improvement of their QoL.

Concordance between bronchial hyperresponsiveness, fractional exhaled nitric oxide, and asthma control in children.

Previous studies on association between level of asthma control, markers of airway inflammation and the degree of bronchial hyperresponsiveness (BHR) have yielded conflicting results. Our aim was to determine the presence and severity of BHR and the concordance between BHR, asthma control, and fractional exhaled nitric oxide (FeNO) in children with asthma on therapy. In this cross-sectional observational study, children (aged 6-18 years) with asthma on British Thoracic Society (BTS) treatment steps 2 or 3, underwent comprehensive assessment of their asthma control (clinical assessment, spirometry, asthma control test [ACT], Pediatric Asthma Quality of Life Questionnaire [PAQLQ]), measurement of FeNO and BHR (using mannitol dry powder bronchial challenge test [MCT], Aridol™, Pharmaxis, Australia). Fifty-seven children (63% male) were studied. Twenty-seven children were on BTS treatment step 2 and 30 were on step 3. Overall, 25 out of 57 (43.8%) children had positive MCT. Of note, 9 out of 27 (33.3%) children with clinically controlled asthma had positive MCT. Analyses of pair-wise agreement between MCT (positive or negative), FeNO (>25 or ≤25 ppb) and clinical assessment of asthma control (controlled or partially controlled/uncontrolled) showed poor agreement between these measures. A substantial proportion of children with asthma have persistent BHR despite good clinical control. The concordance between clinical assessment of asthma control, BHR and FeNO was observed to be poor. Our findings raise concerns in the context of emerging evidence for the role of bronchoconstriction in inducing epithelial stress that may drive airway remodeling in asthma. Pediatr Pulmonol. 2016;51:1004-1009. © 2016 Wiley Periodicals, Inc.

Comparison of Asthma Control Test (ACT) with (GINA) guidelines in the Assessment of Asthma Control and determine if can use Asthmda Control Test ACT as alternative to Gina guidelines in control asthma.

Background: The gold standard in assessing asthma control is the Global Initiative for Asthma (GINA) criteria. And because of the difficulties of access to pulmonary functions tests, The ACT has the added advantage that it does not require lung function assessment.Objectives: The aim of this study is to assess asthma control through ACT score and GINA guideline, and to determine if the ACT can be as useful as the GINA-guidelines criteria in assessing asthma control in Iraq. Patient and method: Cross sectional study with comparing ACT vs. GINA guideline in control of asthma level. This study was conducted at Respiratory consultation unit of the Iraqi National center of early detection of Cancer, Baghdad-Iraq, The study was conducted during the period from 1stNovember 2012 to 1stJuly 2013. A total of 71 adult asthmatic patients who were attended to the respiratory consultant unit were asked to participate and were enrolled in this study regardless their age or gender. Their asthma diagnosed and proved clinically by a combination of history, clinical finding In addition objective measurements using spirometry(FEV1) measured by the reversibility test which is defined as(an increment of&gt;12% or 200 ml ofFEV1 after 20 minutes of administration of inhaled short acting B2-agonist).Result: There were 71 patients enrolled in this study, of them 66 (92.96%) had an ACT score of ≤ 19 ((26) (39.4%) are male),(40)(60.6%) are female ,and 5 patients (7.04%) had an ACT score of &gt; 19 (only(1) (20.0%) is male and and(4)(80.0%) are female. It had been found the number of male is( 27)and(26)(39.4%) out of them had an ACT&lt;19and only(1)(20.0%) had ACT&gt;19 and number of female is(44),(40)(60.6%)outof them had ACT&lt;19 and(4)(80.0%)had ACT&gt;19. No significant differences had been found in between those patients with ≤19 ACT score vs. those with &gt; 19, regarding the age and gender, in both comparison P&gt;0.05 it had been found that good agreement present between ACT and GINA, 92.9%.ACT agreed the GINA in (37 patients with uncontrolled asthma, 24 patients with partially controlled and 5 patients withcontrolled).Conclusion: ACT can serve as an alternative diagnostic tool in assessing asthma control even without an aid of a spirometer or a peak flow meter. An ACT score of more than 19 can classify patient as controlled asthmatic while an ACT score &lt; 19 can classify the patient as uncontrolled and partially controlled asthmatics.

دراسة مقارنة اختبار فحص السيطرةِ على الربو مع البروتوكولات ألعالميه للربو(جينا) في تقييمِ السيطرةِ على الربو وإيجاد إذا يُمْكِنُ أَنْ نستعملَ اختبار فحص السيطرةِ على الربو كبديل أداة إلى البروتوكولات ألعالميه للربو(جينا).

دراسة مقارنة اختبار فحص السيطرةِ على الربو مع البروتوكولات ألعالميه للربو(جينا) في تقييمِ السيطرةِ على الربو وإيجاد إذا يُمْكِنُ أَنْ نستعملَ اختبار فحص السيطرةِ على الربو كبديل أداة إلى البروتوكولات ألعالميه للربو(جينا).

Pathological ILC2 in Peripheral Blood Acts as an Indicator for the Assessment of Asthma Control in Clinics

Pathological ILC2 in Peripheral Blood Acts as an Indicator for the Assessment of Asthma Control in Clinics