The Visual Analog Scale detects exercise-induced bronchoconstriction in children with asthma

N. Lammers*, M. H.T. van Hoesel, M. van der Kamp, M. Brusse-Keizer, J. van der Palen, R. Visser, J. M.M. Driessen, B. J. Thio

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and an important sign of uncontrolled asthma. The occurrence of EIB is insufficiently identified by the Childhood Asthma Control Test (C-ACT) and Asthma Control Test (ACT). This study aimed to (1) evaluate the Visual Analog Scale (VAS) for dyspnea as a tool to detect EIB in asthmatic children and (2) assess the value of combining (C-)ACT outcomes with VAS scores. Methods: We measured EIB in 75 asthmatic children (mean age 10.8 years) with a standardized exercise challenge test (ECT) performed in cold and dry air. Children and parents reported VAS dyspnea scores before and after the ECT. Asthma control was assessed by the (C-)ACT. Results: Changes in VAS scores (ΔVAS) of children and parents correlated moderately with fall in forced expiratory volume in 1 second (FEV1), respectively rs=0.57 (p <.001) and rs=0.58 (p <.001). At a ΔVAS cutoff value of ≥3 in children, sensitivity and specificity for EIB were 80% and 79% (AUC 0.82). Out of 38 children diagnosed with EIB, 37 had a (C-)ACT score of ≤19 and/or a ΔVAS of ≥3, corresponding with a sensitivity of 97% and a negative predictive value of 96%. Conclusion: This study shows that the VAS could be an effective additional tool for diagnosing EIB in children. A reported difference in VAS scores of ≥3 after a standardized ECT combined with low (C-)ACT scores was highly effective in detecting and excluding EIB.

Original languageEnglish
Number of pages7
JournalJournal of asthma
DOIs
Publication statusE-pub ahead of print/First online - 4 Sep 2019

Fingerprint

Bronchoconstriction
Visual Analog Scale
Asthma
Exercise
Exercise Test
Dyspnea
Parents
Forced Expiratory Volume
Area Under Curve
Air
Morbidity
Sensitivity and Specificity

Keywords

  • asthma control
  • Asthma Control Test
  • childhood asthma
  • dyspnea perception
  • Exercise-induced asthma

Cite this

Lammers, N. ; van Hoesel, M. H.T. ; van der Kamp, M. ; Brusse-Keizer, M. ; van der Palen, J. ; Visser, R. ; Driessen, J. M.M. ; Thio, B. J. / The Visual Analog Scale detects exercise-induced bronchoconstriction in children with asthma. In: Journal of asthma. 2019.
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title = "The Visual Analog Scale detects exercise-induced bronchoconstriction in children with asthma",
abstract = "Objective: Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and an important sign of uncontrolled asthma. The occurrence of EIB is insufficiently identified by the Childhood Asthma Control Test (C-ACT) and Asthma Control Test (ACT). This study aimed to (1) evaluate the Visual Analog Scale (VAS) for dyspnea as a tool to detect EIB in asthmatic children and (2) assess the value of combining (C-)ACT outcomes with VAS scores. Methods: We measured EIB in 75 asthmatic children (mean age 10.8 years) with a standardized exercise challenge test (ECT) performed in cold and dry air. Children and parents reported VAS dyspnea scores before and after the ECT. Asthma control was assessed by the (C-)ACT. Results: Changes in VAS scores (ΔVAS) of children and parents correlated moderately with fall in forced expiratory volume in 1 second (FEV1), respectively rs=0.57 (p <.001) and rs=0.58 (p <.001). At a ΔVAS cutoff value of ≥3 in children, sensitivity and specificity for EIB were 80{\%} and 79{\%} (AUC 0.82). Out of 38 children diagnosed with EIB, 37 had a (C-)ACT score of ≤19 and/or a ΔVAS of ≥3, corresponding with a sensitivity of 97{\%} and a negative predictive value of 96{\%}. Conclusion: This study shows that the VAS could be an effective additional tool for diagnosing EIB in children. A reported difference in VAS scores of ≥3 after a standardized ECT combined with low (C-)ACT scores was highly effective in detecting and excluding EIB.",
keywords = "asthma control, Asthma Control Test, childhood asthma, dyspnea perception, Exercise-induced asthma",
author = "N. Lammers and {van Hoesel}, {M. H.T.} and {van der Kamp}, M. and M. Brusse-Keizer and {van der Palen}, J. and R. Visser and Driessen, {J. M.M.} and Thio, {B. J.}",
year = "2019",
month = "9",
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The Visual Analog Scale detects exercise-induced bronchoconstriction in children with asthma. / Lammers, N.; van Hoesel, M. H.T.; van der Kamp, M.; Brusse-Keizer, M.; van der Palen, J.; Visser, R.; Driessen, J. M.M.; Thio, B. J.

In: Journal of asthma, 04.09.2019.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - The Visual Analog Scale detects exercise-induced bronchoconstriction in children with asthma

AU - Lammers, N.

AU - van Hoesel, M. H.T.

AU - van der Kamp, M.

AU - Brusse-Keizer, M.

AU - van der Palen, J.

AU - Visser, R.

AU - Driessen, J. M.M.

AU - Thio, B. J.

PY - 2019/9/4

Y1 - 2019/9/4

N2 - Objective: Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and an important sign of uncontrolled asthma. The occurrence of EIB is insufficiently identified by the Childhood Asthma Control Test (C-ACT) and Asthma Control Test (ACT). This study aimed to (1) evaluate the Visual Analog Scale (VAS) for dyspnea as a tool to detect EIB in asthmatic children and (2) assess the value of combining (C-)ACT outcomes with VAS scores. Methods: We measured EIB in 75 asthmatic children (mean age 10.8 years) with a standardized exercise challenge test (ECT) performed in cold and dry air. Children and parents reported VAS dyspnea scores before and after the ECT. Asthma control was assessed by the (C-)ACT. Results: Changes in VAS scores (ΔVAS) of children and parents correlated moderately with fall in forced expiratory volume in 1 second (FEV1), respectively rs=0.57 (p <.001) and rs=0.58 (p <.001). At a ΔVAS cutoff value of ≥3 in children, sensitivity and specificity for EIB were 80% and 79% (AUC 0.82). Out of 38 children diagnosed with EIB, 37 had a (C-)ACT score of ≤19 and/or a ΔVAS of ≥3, corresponding with a sensitivity of 97% and a negative predictive value of 96%. Conclusion: This study shows that the VAS could be an effective additional tool for diagnosing EIB in children. A reported difference in VAS scores of ≥3 after a standardized ECT combined with low (C-)ACT scores was highly effective in detecting and excluding EIB.

AB - Objective: Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and an important sign of uncontrolled asthma. The occurrence of EIB is insufficiently identified by the Childhood Asthma Control Test (C-ACT) and Asthma Control Test (ACT). This study aimed to (1) evaluate the Visual Analog Scale (VAS) for dyspnea as a tool to detect EIB in asthmatic children and (2) assess the value of combining (C-)ACT outcomes with VAS scores. Methods: We measured EIB in 75 asthmatic children (mean age 10.8 years) with a standardized exercise challenge test (ECT) performed in cold and dry air. Children and parents reported VAS dyspnea scores before and after the ECT. Asthma control was assessed by the (C-)ACT. Results: Changes in VAS scores (ΔVAS) of children and parents correlated moderately with fall in forced expiratory volume in 1 second (FEV1), respectively rs=0.57 (p <.001) and rs=0.58 (p <.001). At a ΔVAS cutoff value of ≥3 in children, sensitivity and specificity for EIB were 80% and 79% (AUC 0.82). Out of 38 children diagnosed with EIB, 37 had a (C-)ACT score of ≤19 and/or a ΔVAS of ≥3, corresponding with a sensitivity of 97% and a negative predictive value of 96%. Conclusion: This study shows that the VAS could be an effective additional tool for diagnosing EIB in children. A reported difference in VAS scores of ≥3 after a standardized ECT combined with low (C-)ACT scores was highly effective in detecting and excluding EIB.

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