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


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
Publication statusE-pub ahead of print/First online - 4 Sep 2019


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

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