Asthma in Children: What Parents Need to Know

Even though healthcare has become better in treating asthma, there still is room for improvement. This is especially true for treating preschool children suspected of having asthma.

Key takeaways:
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    Despite some early study limitations, including work done mostly with children living in urban areas, CHART shows great promise in the early diagnosis and treatment of young children with asthma.
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    Monitoring and validation of CHART in primary care settings still need to be done to evaluate its effectiveness and utility in actual patient care.
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    CHART is low-cost, non-invasive, and efficient.

Current asthma prediction tools for children with high-risk asthma have been lacking. One of the biggest challenges with the diagnosis of asthma appears to be the ambiguity in the clinical definition.

Recently, a group of Canadian researchers working with a large number of pediatric asthma patients reported the development of a simple new symptom-based screening tool called CHART. This new tool is aimed at detecting asthma risk in children as young as two years of age and it appears to be superior to previous techniques.

This new tool is of unquestionable value. It alleviates the use of invasive testing. It represents an exciting new step forward in the diagnosis and treatment of asthma in young children.

What is CHART?

The new non-invasive tool is the first of its kind for the early detection of asthma and persistent wheezing. The overall concept is that if doctors could diagnose children with asthma earlier, then there would be fewer hospitalizations and the costs of healthcare would be less.

The diagnostic study was published in JAMA this year. It described the symptom-based screening tool called Childhood Asthma Risk Tool (CHART).

The study incorporated the results of 2,354 children from January 1, 1989, to 2012 and the data analysis took place from 2019 to May 2022. The results were from Toronto, Ontario, Edmonton, Alberta, Vancouver, BC, and Manitoba in Canada.

The CHART tool diagram is easy to use and follow, as shown below.

CHART tool diagram

The highlights of CHART include the following benefits:

  • Standardized format.
  • Broad-based applicability so it is available even in low-resource settings.
  • Easily flags children at high risk for asthma diagnosis for further investigation by their primary care physicians.
  • Allows monitoring of moderate and low-risk children for asthma.
  • A pragmatic screening tool that is less time-consuming and efficient.
  • Non-invasive.
  • Can be used in children as young as two years of age.
  • Future potential use will be implemented routinely as a part of the electronic medical record beginning in infancy.
  • Alleviates the challenges of clinical diagnosis, particularly in children who are in preschool since there is such variability in symptom severity and remission.

How does CHART compare to what doctors have been doing previously?

Guidelines from the National Asthma Education and Prevention Program, which were updated in 2007, highlighted the importance of correctly diagnosing asthma.

To establish the diagnosis of asthma, the healthcare provider must confirm the following:

  • Episodic symptoms of airflow obstruction are present
  • Airflow obstruction or symptoms are at least partially reversible
  • Alternative diagnoses are excluded

Obtaining a good patient history is crucial when diagnosing asthma and excluding other causes.

The healthcare provider should establish whether the patient has any of the following symptoms:

  • Wheezing
  • Cough
  • Cough at night
  • Cough during or after exercise
  • Shortness of breath
  • Chest tightness
  • Sputum production

According to the National Asthma Education and Prevention Program guidelines, spirometry is an essential objective measure for establishing the diagnosis of asthma.

Spirometry is a simple test where the patient breathes in and out forcefully. In young children, it is often difficult to get the child to cooperate with instructions.

Other tests have similar limitations in getting the child to cooperate, including:

Exercise challenge.

Methacholine challenge. This involves the child inhaling methacholine through an inhaler to confirm the asthma diagnosis.

Measuring the fraction of exhaled nitric oxide (FeNO) which a non-invasive test.

Chest X-ray and CT scans of the lungs and sinuses.

Allergy testing (skin or blood).

More invasive testing such as bronchoscopy or taking a lighted endoscope to look into the child’s airways and lungs.

Why is the CHART tool so significant?

The goals for therapy are as follows:

Control asthma by reducing impairment through the prevention of chronic and troublesome symptoms (eg, coughing or breathlessness in the daytime, at night, or after exertion).

Reduce the need for use of inhalers such as a short-acting beta2-agonist (SABA) for quick relief of symptoms (not including prevention of exercise-induced bronchospasm).

Maintain near-normal pulmonary function.

Maintain normal activity levels (including exercise and other physical activity and attendance at work or school).

Satisfy patients' and families' expectations for asthma care.

Using CHART, the goals for early diagnosis are preventing reduced lung growth and providing optimal medication strategies with minimal or no adverse effects. Additionally, the prevention of acute exacerbations will be more effective as well as avoiding potential environmental allergens and irritants in these susceptible children.

CHART has the potential to either enhance or replace many of the prior methods in the diagnosis, treatment, and management of young children with asthma.

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