Asthma control test

The Childhood Asthma Control Test is a reliable tool for assessing the effectiveness of treatment for asthma.

Since the main goal of treatment for patients with asthma is to achieve and maintain long-term control of the disease, therapy should begin with an assessment of current asthma control, and the amount of treatment should be regularly reviewed to ensure control.

The complexity and labor intensity of asthma control assessment as an integral indicator in real-life practice necessitates the introduction and use of adequate and effective tools. In the process of developing methods for the combined determination of control, several assessment tools have emerged, including questionnaires - ACQ (Asthma Control Questionnaire). RCP (Royal College of Physicians), Rules of Two, etc. for older children. One of the simplest methods that has demonstrated high reliability of asthma control assessment in real-life clinical practice is the Asthma Control Test questionnaire . Its use is recommended by GINA, 2006. Until early 2007, the Asthma Control Test was available only for adults and children over 12 years of age, but in 2006 its pediatric version was proposed, which currently serves as the only tool for assessing asthma control in children aged 4-11 years.

The Childhood Asthma Control Test consists of seven questions, with questions 1-4 intended for the child (4-point rating scale: from 0 to 3 points), and questions 5-7 for parents (6-point scale: from 0 to 5 points). The test result is the sum of the scores for all answers in points (the maximum score is 27 points), the value of which will determine recommendations for further treatment of patients. A score of 20 points or more on the Childhood Asthma Control Test corresponds to controlled asthma, 19 points or less means that asthma is not controlled effectively; the patient is recommended to seek help from a doctor to review the treatment plan. In this case, it is also necessary to ask the child and his/her parents about the medications for daily use, to ensure that the inhalation technique is correct and the treatment regimen is followed.

The purposes of using the Asthma Control Test are:

• screening patients and identifying patients with uncontrolled asthma;
• making changes to treatment to achieve better control;
• increasing the efficiency of implementation of clinical guidelines;
• identification of risk factors for uncontrolled asthma;
• monitoring the degree of asthma control by both clinicians and patients in any setting.

Conceptually, the questionnaire corresponds to the set of asthma treatment goals in the updated GINA guidelines (2006), as it is aimed at achieving the maximum result for each asthma patient. It allows for the assessment of various aspects of the patient's condition and the treatment being administered, is convenient for use in outpatient or inpatient settings, and is sensitive to changes in the patient's condition. The questionnaire is easy to use for medical personnel and patients. Finally, the result is easy to interpret, it is maximally objective, and allows for the assessment of asthma control over time. This test is recommended for use by the main international guidelines for the diagnosis and treatment of bronchial asthma - GINA (2006).

The national program "Bronchial Asthma in Children. Treatment Strategy and Prevention" places great emphasis on regular medical observation and training parents and children in self-monitoring methods. For this purpose, peak flowmetry with a system of color zones (similar to a traffic light signal) is used.

Green Zone: The child is stable, symptoms are absent or minimal. Peak expiratory flow rate is more than 80% of normal. The child can lead a normal life, not take medications or continue the therapy prescribed by the doctor without changes.

Yellow zone: moderate asthma symptoms appear - episodes of coughing and wheezing, malaise, peak expiratory flow rate less than 80% of the age norm.

In this case, it is necessary to increase the volume of treatment, additionally take medications recommended by the doctor. If the condition does not improve within 24 hours, a doctor's consultation is necessary.

Red zone: poor health, coughing fits, suffocation, including night attacks. Peak volumetric flow rate is less than 50%. All this is an indication for urgent consultation with a doctor. If the patient has previously taken hormonal drugs, it is necessary to immediately give the patient prednisolone orally in the dose recommended by the doctor and urgently hospitalize the patient.

First aid at the outpatient stage for mild and moderate bronchial asthma in cases of exacerbation: inhalations of short-acting beta-agonists are used (1 breath every 15-30 seconds - up to 10 inhalations) through a nebulizer. If necessary, inhalations are repeated at intervals of 20 minutes 3 times within an hour.

In case of exacerbation of severe bronchial asthma, bronchodilators are prescribed via a nebulizer; the effect of beta-agonists is enhanced by the administration of ipratropium bromide via a nebulizer at 0.25 mg every 6 hours. In patients with severe bronchial asthma who have previously received corticosteroids or are on ICS therapy, systemic corticosteroids are prescribed in a short course in tablets or intravenously every 6 hours. Inhalations of budesonide (Pulmicort) via a nebulizer at a dose of 0.5-1 mg/day have a good effect for stopping exacerbations.

First aid for an acute attack: provide access to fresh air; place the child in a comfortable position; determine the cause of the attack and eliminate it if possible; give warm drinks; inhale a bronchodilator using a nebulizer; if breathing difficulty persists, repeat the procedure after 20 minutes; if there is no effect from inhalation of the bronchodilator, administer intravenous euphyllin and glucocorticosteroids. If these measures are ineffective within 1-2 hours, the patient must be hospitalized.

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