This study from Turkey included 76 children 6 to 11 years of age (mean age 8.7) with asthma who completed Childhood Asthma Control Test (C-ACT) and underwent fractional concentration of exhaled nitric oxide (FeNO) and spirometric measurements during the monthly clinic visits.A C-ACT score of 22 or less had 69% sensitivity and 77% specificity in determining not well-controlled asthma, whereas an FeNO value of 19 ppb or higher had 61% sensitivity and 59% specificity. Receiver operating characteristic curve analysis revealed that the C-ACT was better than FeNO for identifying patients with uncontrolled asthma.
A C-ACT score of 22 or less (odds ratio, 8.75) and an FeNO of 19 ppb or greater (odds ratio, 2.60) were indicators for uncontrolled asthma.
The authors concluded that C-ACT is superior to FeNO in determining the control status of children with asthma. Editor’s note: Measurement of fractional concentration of exhaled nitric oxide (FeNO) has its place in the care of adults and children and is incorporated in the asthma guidelines (http://ajrccm.atsjournals.org/content/184/5/602.abstract). However, considering the cost of the device (for example, Niox Mino is priced above $3,000 in the U.S.), the use of a simple paper- or computer-based C-ACT score test has obvious cost-saving advantages. It is encouraging to have the scientific evidence that supports that this cost-saving approach can also be more accurate in children with asthma.
References:
Identifying uncontrolled asthma in children with the childhood asthma control test or exhaled nitric oxide measurement. Yavuz ST, Civelek E, Sahiner UM, Buyuktiryaki AB, Tuncer A, Karabulut E, Sekerel BE. Ann Allergy Asthma Immunol. 2012 Jul;109(1):36-40. Epub 2012 May 31.
Childhood Asthma Control Test - Asthma.com by GSK http://bit.ly/RicZ8l
The Childhood Asthma Control Test∗: Retrospective determination and clinical validation of a cut point to identify children with very poorly controlled asthma. JACI, 2010 http://bit.ly/Rid5Nl
Comments from Twitter:
Dr John Weiner @AllergyNet: Reassuring. Many of us use ACT
Here are my suggestions for some of the top articles about immunotherapy for August 2012:
The use of inhaled glucocorticoids (ICS) for persistent asthma causes a temporary reduction in growth velocity in prepubertal children. The resulting decrease in attained height 1 to 4 years after the initiation of inhaled glucocorticoids is thought not to decrease attained adult height. 
A recent analysis from the USA attributed 18,000,000 lost work days annually to PM2.5 exposure, and 11,000,000 school absence days to ozone exposure. Mortality increases by 6–8% for every 10 μg·m−3 increase in long-term PM2.5 concentrations in the community.
Trying to understand factors that are associated with an increased risk of developing inflammatory bowel disease (IBD) is a subject of interest to many readers of our journal and in turn families of patients who experience this chronic gastrointestinal illness. It is for that reason I call your attention to an article by Kronman et al. (doi: 10.1542/peds.2011-3886) who report on a retrospective cohort study in the UK of more than 1 million children followed for the development of IBD in the setting of those exposed and not exposed to anti-aerobic antibiotics. The younger a child was when receiving an antibiotic, and the more courses received, the stronger the association with new onset IBD. As to what antibiotics demonstrated this association, and how usage of these drugs might play a role in the development of IBD, these are two great reasons to digest the information contained in this intriguing study.