Which Parameters Are Most Useful in Determining Asthma Severity in Childhood?

The following poster demonstrates the need for a thorough assessment and evaluation of a child with asthma. As we know it’s very simple to differentiate mild from severe asthma, however, differentiating and making the correct diagnosis and treatment of children with mild and moderate asthma is complex. In this poster, discussed at the 2010 ATS in New Orleans, multiple parameters were evaluated, but only 4 of the parameters evaluated (inhaled Corticosteroid dose, exacerbations per year, hospitalizations/year and exhaled Nitric Oxide) were able to differentiate all types of asthma (mild, moderate and severe). The graphs show all the parameters evaluated, the shadowed graphs demonstrate the parameters that differentiate all 3 groups. As we can see FEV1/FVC and exhaled nitric oxide were two fundamental in the diagnoses of asthma. Two other parameters (exacerbations/year and dose of inhaled corticosteroid) under impairment and risk category were significant. Therefore we can conclude for this cohort of 61 pediatric patients, that clearly the addition of biomarkers such as FeNO adds great value to the correct diagnoses of asthma. We should also emphasize that we cannot depend only on spirometry as the sole tool to diagnose asthma. Of great importance, is the complete evaluation and assessment of impairment and risk factors as they provide vital information for the diagnosis that leads to the proper management of asthma.

Jonathan Malka, MD