Rita Amaral

Validation of Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) - a prospective multicenter study

Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) is the first questionnaire that assesses simultaneously allergic rhinitis and asthma control in children. It was recently developed, but redundancy of questions and its psychometric properties were not assessed. This study aimed to (i) establish the final version of the CARATKids questionnaire and (ii) evaluate its reliability, responsiveness, cross‐sectional validity, and longitudinal validity.

Asthma control in the Portuguese National Asthma Survey.

INTRODUCTION We aimed (1) to measure asthma control using a structure-questionnaire and patient self-perception of asthma-control in the Portuguese National Asthma Survey (INAsma) and (2) to study the relationship between asthma control and asthma-related quality of life. METHODS We analyze data of asthma patients from a cross-sectional, nationwide telephone interview study - INAsma. Controlled asthma was defined as CARAT global score >24 or CARAT lower airways score ≥16. Mini-AQLQ was used to measure quality of life. RESULTS Two hundred and seven (56.9% [95%CI: 51.8-62.0]) of the 364 patients had controlled asthma. Most patients with non-controlled asthma (88%) perceived their disease as controlled. Patients with controlled asthma presented higher mini-AQLQ scores (median, P25-P75; 6.6, 6.0-6.9) than those with non-controlled asthma (4.9, 3.7-5.7) (p<0.001) and a significant positive correlation between CARAT and mini-AQLQ scores was observed (r=0.706; p<0.001). CONCLUSION More than half of the Portuguese patients presented controlled asthma and showed significantly better asthma-related quality of life. Almost 9 out of 10 patients with non-controlled disease have poor perception of their asthma control, which may hinder them from seeking better asthma control.

Cost of asthma in children: a nationwide, population‐based, cost‐of‐illness study

Childhood asthma is very prevalent and costs can be high, especially in severe disease. This study aimed to estimate the cost of asthma in Portuguese children and the variations by level of asthma control.

Use of the Control of Allergic Rhinitis and Asthma Test (CARATkids) in children and adolescents; validation in Dutch

Allergic rhinitis and asthma are common and closely related diseases. Recently, a Portuguese questionnaire has been developed ‘The Control of Allergic Rhinitis and Asthma Test’ (CARATkids) that measures disease control of both diseases in children. This study aims to validate the CARATkids in Dutch children and for the first time in adolescents and, in addition, to calculate the minimal clinically important difference (MCID).

Exhaled NO reference limits in a large population-based sample using the Lambda-Mu-Sigma method

Absolute values are used in the interpretation of the fraction of exhaled nitric oxide (FeNO), but it has been suggested that equations to calculate reference values may be a practical and clinically useful approach. We hypothesize that the application of the Lambda-Mu-Sigma (LMS) method may improve FeNO reference equations and their interpretation. Our aims were to develop FeNO reference equations with the LMS method and to describe the difference between this method and the absolute fixed cut-offs of the current recommendations. We utilized the United States National Health and Nutrition Examination Surveys 2007-2012 and included healthy individuals with no respiratory diseases and blood eosinophils <300/mm3 ( n = 8,340). Natural log-transformed FeNO was modeled using the LMS method, imbedded in the generalized additive models for location, scale, and shape models. A set of FeNO reference equations was developed. The explanatory variables were sex, age, height, smoking habits, and race/ethnicity. A significant proportion of individuals with normal FeNO given by the equations were classified as having intermediate levels by the current recommendations. Further lower predicted FeNO compared with previous linear models was seen. In conclusion, we suggest a novel model for the prediction of reference FeNO values that can contribute to the interpretation of FeNO in clinical practice. This approach should be further validated in large samples with an objective measurement of atopy and a medical diagnosis of asthma and rhinitis. NEW & NOTEWORTHY Novel reference equations and fraction of exhaled nitric oxide (FeNO)-predicted values to improve interpretation of FeNO in clinical practice are presented. These may increase the accuracy of ruling out airway inflammation in patients with asthma or suspected asthma.

Phenotypes of airway diseases in preschool children

Aims: To identify and characterize phenotypes of airway diseases (wheezing and rhinitis) in preschoolers. Methods: This is a post-hoc analysis of a cross-sectional, population-based study including a representative sample of 3-5 years Portuguese children (Allergy2013;68:1278-88). Data was collected by face-to-face interview to caregivers using an adapted ISAAC questionnaire. We selected 2557 (51%) children with ≥1 nasal symptom (sneezing/itchy nose, rhinorrhoea or blocked nose) and/or wheezing in the previous 12 months. Phenotypes were identified by latent class analysis using data on respiratory symptoms/diagnoses and on demographic characteristics (2161 included). Results: We identified 4 phenotypes. All children in phenotype 1 (n=392; 18%) presented rhinitis and 57% had wheezing; most had mild intermittent rhinitis (95%) characterized by rhinorrhoea (100%) and almost none had rhinitis medical diagnosis (5%) or treatment (5%). Phenotype 2 (n=782; 36%) was characterized by mild intermittent rhinitis (88%) with predominant obstruction (94%); only 16% reported wheezing. Phenotype 3 (n=629; 29%) presented the highest proportion of moderate-severe persistent rhinitis (20%); almost 60% had physician-diagnosed rhinitis and treatment in the previous year; 60% had wheezing (62% presented ≥4 episodes and 62% needed treatment) and 21% reported physician-diagnosed asthma. Phenotype 4 (n=358, 17%) was characterized by wheezing (96%) without rhinitis; 26% had ≥4 wheezing episodes, 36% had treatment for wheezing in the previous year and 16% had physician-diagnosed asthma. Conclusions: The four identified phenotypes of preschool airway diseases diverge in rhinitis and wheezing prevalence and in their severities and treatment needs.