Stanley J Szefler

Reply: To PMID 24290281.

To the Editor: The correspondence from Chipps et al highlights a new questionnaire for preschool children titled the ‘‘Test for Respiratory and Asthma Control in Kids’’ (TRACK). Although our recent review on childhood asthma indeed stated that ‘‘there are no instruments available [for asthma control] for children in the 0to 4-year age group,’’ that statement was adapted from the recent National Institutes of Health and the Agency for Healthcare Research and Quality Asthma Outcomes Workshop Report, which identified no core or supplemental measures for baseline characterization or prospective efficacy analyses in children younger than 4 years. It is important to note that this Asthma Outcomes Workshop Report was published in February 2012, and at that time, only 1 publication on the TRACK instrument was available. Although this TRACK publication was promising in that it demonstrated more than 80% correct classification of preschool childrenwith asthma-like respiratory disease, theWorkshop committee was constrained to strict definitions of ‘‘core’’ and ‘‘supplemental’’ outcome measures of asthma control, which were largely based on well-documented standardization of methods and crosssectional and longitudinal validity. Consequently, the TRACK questionnaire was named as an ‘‘emerging’’ outcome given its potential to improve disease monitoring, although it was recognized that further studies were needed at the time. As Chipps et al correctly point out, several key articles on the TRACK questionnaire have been published since the Asthma Outcomes Workshop. There is now evidence supporting both the clinical meaningfulness and the longitudinal validity of the TRACK tool in 20 representative pediatric practices in the United States. The reliability of the TRACK questionnaire in a Turkish population of preschool children has also been established, suggesting that the tool may be of relevance to the larger global community of asthma physicians. Although clinical trials utilizing the TRACK questionnaire are yet to be conducted, it may now be appropriate to move this new assessment tool from the ‘‘emerging’’ category of research. Given the limited number of available questionnaires for the assessment of asthma control in young children, the TRACK tool may offer novel advantages for future pharmaceutical study in young children. Stanley J. Szefler, MD James F. Chmiel, MD, MPH Anne M. Fitzpatrick, PhD George Giacoia, MD Thomas P. Green, MD Daniel J. Jackson, MD Heber C. Nielsen, MD Wanda Phipatanakul, MD, MS Hengameh H. Raissy, PharmD From the Department of Pediatrics and Pharmacology, National Jewish Health, and the University of Colorado School of Medicine, Denver, Colo; University Hospitals Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio; Emory University Department of Pediatrics and Children’s Healthcare of Atlanta Center for Developmental Lung Biology, Atlanta, Ga; the National Institute of Child Health and Development, Bethesda, Md; Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill; the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, Mass; Boston Children’s Hospital and Harvard Medical School, Boston, Mass; and the Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM. E-mail: Stanley.szefler@childrenscolorado.or. Disclosure of potential conflict of interest: S. J. Szefler has received consultancy fees from Merck, Genentech, Boehringer Ingelheim, and GlaxoSmithKline; has received research support from GlaxoSmithKline; has received lecture fees from Merck; has received payment for manuscript preparation from Genentech; and has a pending patent with the National Heart, Lung, and Blood Institute (NHLBI) CARE Network for a beta adrenergic receptor polymorphism. J. F. Chmiel has received consultancy fees from Genentech, CSL Behring, and Boehringer Ingelheim; has received research support and honoraria for grant reviews from the National Institutes of Health and the Cystic Fibrosis Foundation; has received payment for the development of educational presentations from KaloBios Pharmaceuticals; has received travel support from the American College of Chest Physicians; and has received honorarium from the American Board of Pediatrics for question writing activities. A. M. Fitzpatrick has received consultancy fees from MedImmune, Merck, GlaxoSmithKline, Genentech, and Boehringer Ingelheim. D. J. Jackson has received consultancy fees from GlaxoSmithKline and Genentech. W. Phipatanakul has received research support from the National Institutes of Health. H. H. Raissy has received research support from the NHLBI/subcontract with National Jewish Health and has received travel support from Genentech. The rest of the authors declare that they have no relevant conflicts of interest.

Chapter 19 – Future Directions in Asthma Management

We currently depend on asthma guidelines to summarize novel research related to asthma management. However, new data emerge so frequently and rapidly that neither guidelines nor physicians can keep up to date. Therefore, novel mechanisms must be developed to evaluate relevant new information and apply it to patient care as soon as possible. In addition, rapid changes are occurring in the healthcare system that require data sharing and collaboration. As these two areas evolve, we will enter a new era in disease management that will lead to better outcomes and reduced morbidity and mortality related to respiratory disease.