Measuring burden of asthma flare-up in young children

Published Online: September 2, 2015

Preschool age children suffer the highest morbidity from asthma and wheezing flare-ups. Therapeutic advances have been hampered by the lack of discriminative and responsive health outcomes applicable to this young age group. Unable to cooperate with traditional lung function testing, health outcomes used to document severity and treatment response have focused primarily on health care, e.g., acute care visits, or medication utilization (rescue oral corticosteroids).  While the majority of preschool flare-ups do not result in one of these outcomes, they still carry significant symptom burden at home that is largely unmeasured. A valid measure to document the overall burden of an asthma exacerbation on the functional status of preschoolers would provide an important and complementary outcome to assess response to therapy.

In a recently published study in The Journal of Allergy and Clinical Immunology (JACI), the authors use a rigorous 5-step process involving parents of preschool-aged children with asthma flare-ups to ascertain the burden of symptoms during acute asthma exacerbations in children aged 1-6 years. They then ascertained its psychometric properties in the context of a therapeutic randomized controlled trial of 129 children with recurrent viral-induced asthma. The caregiver-completed 17-item instrument, entitled Asthma Flare-up Diary for Young Children (ADYC), is completed by parents daily during an asthma flare-up. The instrument has demonstrated high feasibility, internal validity, test-retest reliability, discriminative abilities, and responsiveness to change. Rated daily on a scale of 1 (best) to 7 (worst), the minimally important difference between two consecutive days was 0.22, showing high day-to-day responsiveness. The cumulative ADYC score during an episode discriminated very well between exacerbations requiring rescue oral corticosteroids or health care utilization versus those that did not, and between children with respiratory viral illness with and without asthma exacerbations. Moreover, the cumulative episode ADYC was highly responsive to identify an overall reduction in the severity of episodes between an effective intervention (pre-emptive high-dose fluticasone) and a placebo, in the context of the randomized clinical trial.

The ADYC carries key psychometric properties to explore the burden of asthma symptoms in preschool-aged children, and to discriminate across various levels of episode severity, including between those with exacerbation and those with simple colds. Validated in Canadian English and French, the ADYC is offered as an asthma-specific research instrument to monitor change in functional status occurring day-to-day or over the short duration of an exacerbation in preschool-aged children with asthma.

The Journal of Allergy and Clinical immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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