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

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

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

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    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
    Pages (from-to)1347-1353
    Number of pages7
    JournalJournal of asthma
    Issue number12
    Early online date4 Sept 2019
    Publication statusPublished - 2020


    • asthma control
    • Asthma Control Test
    • childhood asthma
    • dyspnea perception
    • Exercise-induced asthma
    • n/a OA procedure


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