Asthma Flare-up Diary for Young Children to monitor the severity of exacerbations.
BACKGROUND
Few instruments exist to ascertain the severity of a preschool-aged child's asthma exacerbations managed at home.


OBJECTIVE
We sought to develop and validate a functional status instrument to assess asthma exacerbation severity in preschoolers.


METHODS
The parent-completed Asthma Flare-up Diary for Young Children (ADYC), which was developed systematically, comprises 17 items, each scored from 1 (best) to 7 (worst). The ADYC was completed daily from the onset of an upper respiratory tract infection (URTI) until asthma symptom resolution; the cumulative daily score was reported. The ADYC was examined for key psychometric properties in a randomized placebo-controlled trial of pre-emptive high-dose fluticasone in preschoolers with URTI-induced asthma.


RESULTS
In 121 children aged 2.7 ± 1.1 years (59.5% male), the ADYC's internal consistency (Cronbach α = .97), feasibility (97% completion), and test-retest reliability (r = 0.71; 95% CI, 0.59-0.80) were demonstrated. The ADYC was responsive to change between 2 consecutive days (Guyatt statistic = 0.77) with a minimal important difference of 0.22 (0.17-0.27). Of 871 episodes, the cumulative ADYC score was significantly higher during exacerbations than during URTIs (mean difference [MD], 7.6; 95% CI, 6.4-8.9) and for exacerbations with an acute-care visit (MD, 9.1; 95% CI, 7.6-10.7), systemic corticosteroids (MD, 10.1; 95% CI, 8.3-12.0), and hospitalization (MD, 6.8; 95% CI, 2.9-10.7) versus those without. In children receiving fluticasone, the ADYC score was significantly lower versus that in the placebo group (MD, 5.1; 95% CI, 1.8-8.3).


CONCLUSIONS
The 17-item ADYC proved feasible, responsive to day-to-day changes, and discriminative across exacerbations of different severities. In a trial testing effective therapy in preschoolers, it identified a significant reduction in asthma exacerbation severity.
Departments of Pediatrics and Social and Preventive Medicine, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada; Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada. Electronic address: Francine.m.ducharme@umontreal.ca.
Francine M
FM
Ducharme
Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada.
Megan E
ME
Jensen
Department of Psychology, McGill University, Montreal, Quebec, Canada.
Morton J
MJ
Mendelson
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Patricia C
PC
Parkin
Unité de recherche clinique appliquée, Research Center, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Quebec, Canada.
Eve
E
Desplats
Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Xun
X
Zhang
Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada; Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
Robert
R
Platt
D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D000068298:Fluticasone / Q000008:administration & dosage / Q000627:therapeutic use; D055991:Health Records, Personal; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index
D018927:Anti-Asthmatic Agents; D000068298:Fluticasone
Asthma; discrimination; preschool child; questionnaire design; randomized controlled trial; reliability and validity