The Childhood Asthma Control Test*: Retrospective determination and clinical validation of a cut point to identify children with very poorly controlled asthma
The Childhood Asthma Control Test*: Retrospective determination and clinical validation of a cut point to identify children with very poorly controlled asthma
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DOI：
10.1016/j.jaci.2010.05.031
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发表时间：
2010-08-01
影响因子：
14.2
通讯作者：
McDonald, Jeffrey
中科院分区：
文献类型：
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作者：
Liu, Andrew H.;Zeiger, Robert S.;McDonald, Jeffrey
背景：儿童哮喘控制测试（C-ACT）在将4至11岁儿童分为“控制良好”或“控制不良”哮喘方面已被证明是有效的。然而，新的哮喘管理指南区分了3个级别的哮喘控制。目的：我们试图确定C-ACT的第二个切点，以识别“控制非常差”的哮喘儿童。方法：对671例儿童资料进行二项logistic回归分析。专家的控制等级是标准测量。专家的严重程度评分、专家对治疗的评估和预测的fev1%被用来评估切点的临床有效性。结果：选择截断点12，因为它正确地将最高百分比的参与者（66.3%）分类为“控制非常差”（vs“控制不佳”）哮喘，并显示出高特异性（89.8%）和中度阳性预测值（69.1%）。与13至19分相比，12分或更低的儿童预测的平均fev1%较低（79.8%对92.6%,P = 0.0002），并且更频繁地加强治疗（72.9%对53.6%,P = 0.0131），并被评为患有严重哮喘（13.6%对4.5%,P = 0.0005）。1个月后，两组间C-ACT评分和肺功能的显著差异持续存在。“控制非常差”组的C-ACT平均得分显著低于“控制不佳”组（分别为17.2比20.3,P = 0.0001）。结论：C-ACT的第二个分割点为12或更低，表明控制水平最低的儿童有较差结局的风险，并且在概念上与哮喘管理指南采用的“控制非常差”哮喘分类一致。[J]过敏症临床与免疫杂志，2010;26:267-73。
Background: The Childhood Asthma Control Test (C-ACT) has demonstrated validity in classifying children aged 4 to 11 years as having either "well-controlled'' or "not well-controlled'' asthma. However, new asthma management guidelines distinguish 3 levels of asthma control.Objective: We sought to determine a second cut point on the C-ACT to identify children with "very poorly controlled'' asthma. Methods: Binomial logistic regression was performed on data from 671 children. The specialist's rating of control was the criterion measure. Specialists' severity ratings, specialists' assessment of therapy, and FEV1 percent predicted were used to assess the clinical validity of the cut point.Results: A cut point of 12 was selected because it correctly classified the highest percentage of participants (66.3%) as having "very poorly controlled'' (vs "not well controlled'') asthma and demonstrated high specificity (89.8%) and moderate positive predictive value (69.1%). Children scoring 12 or less versus 13 to 19 had lower mean FEV1 percent predicted (79.8% vs 92.6%, P = .0002) and were more frequently stepped up in therapy (72.9% vs 53.6%, P = .0131) and rated as having severe asthma (13.6% vs 4.5%, P = .0005). One month later, significant differences in C-ACT scores and lung function between these 2 groups persisted. The mean C-ACT score of participants classified as "very poorly controlled'' was significantly lower than that of participants classified as "not well-controlled'' (17.2 vs 20.3, respectively; P = .0001).Conclusion: A second cut point of 12 or less on the C-ACT identifies children with the lowest level of control, who are at risk for poorer outcomes, and is conceptually consistent with the classification of "very poorly controlled'' asthma adopted by asthma management guidelines. (J Allergy Clin Immunol 2010;126:267-73.)