Asthma control in preschool wheezing children

Background: There is no gold standard for the assessment of asthma control, although GINA guidelines are commonly used. The TRACK (Test for Respiratory and Asthma Control in Kids) is the only asthma and wheezing questionnaire for use in preschool children. Aim: To study the agreement between different respiratory control levels obtained by distinct methods in recurrent wheezing (RW) children. Methods: 63 preschool children with diagnosed RW participated in a medical assessment that included the classification of the respiratory control according to GINA and a visual analogic scale (VAS). Parents filled in the TRACK questionnaire and classified the asthma control according to a VAS. Children performed also a spirometry. The Cohen9s kappa and Spearman rank correlation were used. A ROC analysis was done to study the accuracy of the TRACK. Results: 54% of the children were males, mean age: 4.9 years (SD: 0.68). Regarding the lack of control, 40% and 52% had asthma uncontrolled by the TRACK and GINA. Airways obstruction was found in 11% and 21% through FEV 1 and FEV 0.75 . The agreement of TRACK and GINA was moderate (kappa=0.50). The agreement between spirometric parameters and TRACK or GINA was poor. TRACK score was well correlated with Medical and Parental VAS scores. The TRACK presented a good discriminating ability (AUC: 0.82) to distinguish controlled from uncontrolled children according to the GINA. The optimal TRACK score was 80 (sensitivity: 82%; specificity: 70%). Conclusions: The good diagnostic performance of the TRACK in the assessment of the levels of asthma control, based on GINA criteria, supports their use in preschool wheezing children. Spirometry could complement the respiratory evaluation of pre-school children.