Asthma flare-up dairy for young children

The Asthma flare-up dairy for young children is a validated 17-item questionnaire, completed by caregivers, to assess the day-to-day change in asthma severity in preschool-aged children during an acute exacerbation. The Asthma flare-up dairy for young children has been shown to reliably discriminate across severity levels and response to treatment in children aged 1 to 6 years.

It is intended for the home assessment, by caregivers, of the overall exacerbation severity as well as the day-to-day change in status of preschool-aged children during an asthma exacerbation. This instrument was developed to test the impact of an intervention on the severity of an exacerbation whether entirely managed at home or following an acute care consultation.

The Asthma flare-up dairy for young children was developed using the standard Kirshner and Guaytt's approach for instrument development. The item generation conducted by an extensive literature review and in 25 caregivers yielded 135 candidate items. The item reduction using factor analysis based on the product of endorsement by importance of each item rated by 104 caregivers reduced the instrument to 17 items. Item presentation and scaling allowed the wording of these 17 items as questions and provided response options on a Likert scale of 1 (best) to 7 (worst). Using the back-translation technique, we simultaneously designed and tested the French and English versions. Finally, 24 caregivers served to test the clarity of the Asthma flare-up dairy for young children in both the French and English versions.¹

The Asthma flare-up dairy for young children was validated in the context of a published randomised controlled trial of pre-emptive high-dose fluticasone at the onset of an upper respiratory tract infection in preschool-aged children with viral-induced asthma.²

The Asthma flare-up dairy for young children is a 17-item score, in which each item is equally weighted and coded on a scale of 1 (best) to 7 (worst). The items pertain to cough (N=2), wheeze (N=2), dyspnea (N=4), night awakenings (N=1), general well-being (N=5), and the child's response to albuterol (salbutamol) inhalations (N=3). The total daily score ranges from 17 (best) to 119 (worst). The instrument should be completed daily from the beginning until the end of asthma symptoms; parents report symptoms for the preceding 24 hours. We recommend that it be completed every evening preferably by the same caregiver, the one with the best opportunity to observe the child over this period.

The intensity of symptoms during an exacerbation is calculated as:

• The average daily score, that is, the sum of the daily scores on the 17-item du PAD, completed daily from beginning until the end of asthma symptoms, divided by the number of days with symptoms.

or

• The standardised daily score, if one wants to adjust for different length of symptoms, by dividing the average daily score by the number of days multiplied by a constant, representing the mean or median number of days with symptoms.

The Asthma flare-up dairy for young children has been used as a research instrument in the context of a published randomised controlled trial of pre-emptive high-dose fluticasone at the onset of an upper respiratory tract infection in preschool-aged children with viral-induced asthma and several ongoing trials.^2,3

• Canadian English
• Canadian French

• American Spanish

1. Ducharme, FM, Mendelson, MJ, Klassen, TP, et al. The Preschool Asthma Diary (PAD): A validated instrument for day-to-day monitoring of asthma severity in young children. Pediatric Academic Societies, 2007:6310.6. (Accessed November 11, 2007, at http://www.abstracts2view.com/pasall).
2. Ducharme FM, Lemire C, Noya FJ, Davis GM, Alos N, Leblond H, Savdie C, Dollet JP, Rivard G, Platt RW. Preemptive high-does fluticasone for viral-induced asthma in preschool-aged children: a randomized controlled trial. New Engl J Med 2009;360:339-53. http://www.ncbi.nlm.nih.gov/pubmed/19164187
3. Mauger D. Treatment of preschool children with upper respiratory tract illnesses using azythromycin and lower respiratory tract symptoms using oral corticosteroids. (APRIL - OCELOT) NCT01272635. http://clinicaltrials.gov/ct2/show/NCT01272635