Asthma and lower airway disease
Test for Respiratory and Asthma Control in Kids (TRACK): A caregiver-completed questionnaire for preschool-aged children

https://doi.org/10.1016/j.jaci.2009.01.058Get rights and content

Background

A validated questionnaire is needed to monitor respiratory control in preschool-aged children.

Objective

We sought to develop and validate a caregiver-completed questionnaire that measures respiratory control in young children.

Methods

A 33-item questionnaire that included asthma impairment and risk items was administered to 486 caregivers of children aged younger than 5 years with a current, recent, or past history of respiratory symptoms. Stepwise regression was used to select a subset of items with the greatest discriminant validity in relation to guidelines-defined asthma control in a random two-thirds development sample. Reliability, validity, and ability to screen for respiratory control problems were tested in development and validation samples (remaining one-third sample).

Results

The content of the 5 items selected, the Test for Respiratory and Asthma Control in Kids (TRACK), included frequency of respiratory symptoms (wheeze, cough, shortness of breath), activity limitation, and nighttime awakenings in the past 4 weeks; rescue medication use in the past 3 months; and oral corticosteroid use in the previous year. Reliability was greater than 0.70 in both samples. ANOVA showed that mean scores differed significantly (P < .001) in the expected direction across both samples for 3 levels of guidelines-based respiratory control, physician-recommended change in therapy, and symptom status. In the development and validation samples, screening analyses revealed areas under the receiver operating characteristic curve of 0.88 and 0.82, respectively; control status was correctly classified in 81% and 78% of cases.

Conclusion

TRACK is a valid, easy-to-administer, caregiver-completed questionnaire of respiratory control in preschool-aged children with symptoms consistent with asthma.

Section snippets

Draft questionnaire development

Development of the draft questionnaire was based on input from a working group, caregiver and physician interviews, and subsequent qualitative research (see the Methods section in this article's Online Repository at www.jacionline.org). Items for the draft questionnaire were based on content generated from 2 focus groups, each consisting of 8 primary caregivers of preschool-aged children with recurring respiratory problems or asthma. Physical signs of respiratory problems most often reported

Total sample

Characteristics of the total sample (N = 486) of caregivers who completed the draft 33-item questionnaire and their children are provided in Table I. Most caregivers were younger than 45 years of age (95.7%), female (88.9%), and white (71.8%). Most children were aged 3 to 5 years (82.1%); had 1 or more episodes of wheezing, coughing, or shortness of breath in the past 4 weeks (61.9%); and had symptoms that were either not well controlled or very poorly controlled (73.7%). Most (61.9%) children

Discussion

The objective of this study was to develop an instrument to measure respiratory and asthma control in preschool-aged children with symptoms consistent with asthma that included the impairment and risk domains of control recommended by the most recent NAEPP guidelines.12 Regular assessment and monitoring of respiratory symptoms and activity limitations are essential in the care of asthma. However, standardized methods for measuring control in clinical settings are not available for

References (24)

  • P.W. Newacheck et al.

    Prevalence, impact, and trends in childhood disability due to asthma

    Arch Pediatr Adolesc Med

    (2000)
  • S.D. Sullivan

    Asthma in the United States: recent trends and current status

    J Manag Care Pharm

    (2003)
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    Supported by AstraZeneca LP.

    Disclosure of potential conflict of interest: K. R. Murphy has received consulting honoraria from AstraZeneca, Schering-Plough, Merck, and Dey and has received research support from AstraZeneca, GlaxoSmithKline, Merck, Schering-Plough, and Novartis. R. S. Zeiger has served as a consultant for AstraZeneca. B. Chipps has received research support from Aventis, Genentech, AstraZeneca, GlaxoSmithKline, Novartis, Schering-Plough, Sepracor, and Merck; has received grants for educational activites from Alcon, Aventis, Genentech, AstraZeneca, GlaxoSmithKline, and Novartis; has served as an advisor for Alcon, Aventis, Genentech, AstraZeneca, GlaxoSmithKline, MedPoint, Novartis, Schering-Plough, Sepracor, and Merck; and has served on the speakers' bureau for Alcon, Aventis, Genentech, AstraZeneca, Boehringer, GlaxoSmithKline, MedPoint, Novartis, Pfizer, Schering-Plough, Sepracor, and Merck. M. Mellon has served as a consultant for AstraZeneca and has served as a speaker for AstraZeneca and Schering-Plough. K. Lampl is employed by AstraZeneca.

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