Asthma and lower airway disease
Monitoring childhood asthma: Web-based diaries and the asthma control test

https://doi.org/10.1016/j.jaci.2013.10.005Get rights and content

Background

Data from asthma diaries are frequently used as an end point in asthma studies; however, data on the validity of Web-based diaries are scarce.

Objectives

First, we examined the validity of a Web-based diary in assessing asthma control. Second, we determined the cutoff points for well-controlled asthma of the Childhood Asthma Control Test (C-ACT) and the Asthma Control Test (ACT), and calculated the minimal important difference for both tests.

Methods

Children with asthma, ages 4-18 years (n = 228) completed a 4-week Web-based diary, C-ACT, ACT, and an asthma-related quality-of-life questionnaire at baseline and after 1-year follow-up.

Results

The completion rate of the Web-based diaries was 89%. The diary scores correlated strongly with C-ACT and ACT scores (r = −0.73, P < .01; r = −0.64, P < .01, respectively) and the changes in diary scores correlated well with changes in C-ACT and ACT scores. The best cutoff points for well-controlled asthma were C-ACT ≥ 22 and ACT ≥ 23. The minimal important differences were 1.9 (95% CI, 1.3-2.5) for ACT and 1.6 (95% CI, 1.1-2.1) for C-ACT, and −0.7 points/d (95% CI, −1.1 to −0.4) for the Web-based diary.

Conclusions

Our Web-based diary was valid for recording asthma symptoms. Cutoff points of ≥22 (C-ACT) and ≥23 (ACT) define well-controlled asthma. We recommend a 2 C-ACT and ACT points difference as minimally important.

Section snippets

Methods

This study is part of the multicenter study BATMAN (Better Asthma Treatment: Monitoring with ACT and Nitric Oxide), a prospective, randomized controlled trial in the Netherlands on new monitoring strategies in children with asthma, with a follow-up of 1 year (trial no. NTR 1995). At baseline (t = 0), parents and children completed a C-ACT or an ACT (if ≥12 years), and fractional exhaled nitric oxide (FENO) was measured (Fig 1). Subsequently, the patients and/or their parents filled in a daily

Results

Two hundred twenty-eight patients (67% boys) participated; their mean (SD) age was 10.5 ± 3.0 years. Baseline characteristics are shown in Table I. Seven patients dropped out because they did not complete 50% of all diaries or they did not show up at their second visit.

Discussion

In this study, we established the feasibility and validity of a Web-based asthma diary to monitor asthma control in children. The correlation between diary scores and C-ACT and ACT was high, and the Web-based diaries were able to detect changes in asthma control. We determined the optimal cutoff for defining well-controlled asthma and the clinically relevant changes in C-ACT score, ACT score, and diary score. Evaluation of symptoms should be a core asthma outcome measure in clinical research,

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    This study is part of the BATMAN study (Better Asthma Treatment: Monitoring with ACT and Nitric Oxide), which was funded by ZonMW Netherlands, Dutch Lung Fund, and Fund Nuts Ohra.

    Disclosure of potential conflict of interest: A. A. Vaessen-Verberne has received one or more payments for educational lectures for general practitioners. H. J. Brackel is a member of the pediatric pulmonology advisory board of GlaxoSmithKline, has received one or more payments for educational lectures for primary physicians and pediatricians on asthma, and has received one or more payments for the development of online educational presentations on asthma. M. W. Pijnenburg has been supported by one or more grants from ZonMW, the Dutch Lung Fund, and Fund NutsOhra, and has received one or more payments for lecturing from GlaxoSmithKline and AbbVie. The rest of the authors declare that they have no relevant conflicts of interest.

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