INTRODUÇÃO À MEDICINA II
What is the relation between the results of the CARAT (Control of
Alergic Rhinitis and Asthma Test) and the ones of lung function tests?
BACKGROUND
1
Background
Justification
• Inflammatory
disease,
affecting the
respiratory
track;
Asthma
Aims Participants/Methods Results
It may be
• Allergic;
• Non-allergic;
Discussion
•
•
•
•
Wheezing;
Dyspnea;
Coughing;
Airway Obstruction;
Symptoms
1- Ito Y, Adachi Y, Itazawa T, Okabe Y, Adachi YS, Higuchi O, Katsunuma T, Miyawaki T. “Association between the Results of
the Childhood Asthma Control Test and Objective Parameters in Asthmatic Children” J Asthma. 2011 Nov 2. [Epub ahead of
print]
BACKGROUND
2
Background
Justification Aims
Participants/Methods
Results
1-
12 – E Bateman, L Boulet, A Cru, M FitzGerald, T Haahtela, M Levy, P O’Byrne, K Ohta, P, Paggiaro, S Pedersen, M SotoQuiro, G Wong, N Barnes, P Barnes, A Becker, J Drazen, R Lemanske, E Pizichini, H Reddel, S Sullivan, S Wenzel – Global
Strategy fot Asthma Management and Prevention http://www.ginasthma.org/pdf/GINA_Report_2010.pdf
BACKGROUND
3
Background
Justification Aims
Asthma
affects about
300 million
people in the
whole world
Participants/Methods
1,08 million
have had the
disease at
sometime in
their lives in
Portugal
Results
Discussion
57% have the
disease
controlled (in
Portugal)
11- M Masoli, D Fabian, S Holt, R Beasley – Global Burden of Asthma http://www.ginasthma.org/pdf/GINABurdenReport.pdf
27- António Bugalho de Almeira, João A. Fonseca, Mário de Almeida, Ana Todo-Bom ETAL, Inquérito Nacional sobre a Asma
(INASma), Dezembro 2010
BACKGROUND
4
Background Justification Aims
Participants/Methods Results
Discussion
Figure 2 – Asthma prevalence on a worldwide basis
11- M Masoli, D Fabian, S Holt, R Beasley – Global Burden of Asthma http://www.ginasthma.org/pdf/GINABurdenReport.pdf
BACKGROUND
5
Background Justification Aims Participants/Methods
Results
Discussion
ASTHMA AND LIFE QUALITY
“Psychological distress was more frequent in those with asthma (17.9% v
12.2%, p<0.01) and a higher proportion with asthma were at higher risk
for anxiety or depression (40.5% v 31.2%, p<0.01)”
“The burden of asthma on individuals and on society includes a substantial impact on
quality of life. There is a widely held view that monitoring the impact of asthma should
include measures of its impact on quality of life. However, there is no generally agreed
approach to population-based monitoring of quality of life in relation to specific chronic
diseases, such as asthma.”
2- Adams, R. J., D. H. Wilson, et al. (2004). "Psychological factors and asthma quality of life: a population based study."
Thorax 59(11): 930-935.
BACKGROUND
6
Background Justification Aims
Participants/Methods Results
Discussion
CARAT questionnaire
Lung Function Tests
The "Control of Allergic Rhinitis and
Asthma Test" (CARAT) is a brief
self-administered questionnaire to
quantify the degree of control of
Allergic Rhinitis and Asthma;
Standard in clinical evaluation,
measures several variables, such as
air intake volume, inhalation and
exhalation speed, presence of
compounds such as NO, and
efficiency of gas exchanges in the
alveoli;
26- Miguel Domingues, Control of Allergic Rhinitis and Asthma Test (CARAT): its applicability in assessment of asthma control in
adult subjects without rhinitis, ECS Universidade do Minho 2011
JUSTIFICATION
7
Background Justification
Aims
Participants/Methods Results Discussion
CARAT Questionnaire
Lung Function Test (LFT)
(Control of Allergic Rhinitis and Asthma Test)
-Zero costs;
-Available on the Internet;
- No need for medical intervention;
- Costs 11€;
-Available only in some health care
institutions;
- Requires medical intervention;
3 - Ruiz Aguirre J, Vilert Garrofa E, Solanas Saura P,
Morera Jordán C, Mallorquí Beltrán C, Mas Marqués
M. “Costs of spirometry as a screening test for chronic
obstructive pulmonary disease in primary care” Aten
Primaria. 2005 Oct 31;36(7):373-7.
JUSTIFICATION
8
Background
Justification Aims
Participants/Methods Results Discussion
• There’s a need to reinforce the use of a wider set of control
measures of asthma
“…in the new GINA guidelines, revised in 2006, emphasis is placed
on the concept that the goal of asthma treatment is to achieve and
maintain clinical control. GINA 2006 recommends the classification of
asthma by the level of control: controlled, partly controlled, or
uncontrolled.”
13 - Toshiro Shirai, Kazuki Furuhashi, Takafumi Soda, Kingo Shida, “Relatioship of the Asthma Control Test with pulmonary
function and exhaled nitric oxide,”Annals of Allergy, Asthma and Immunology”, vol 101 December 2008
JUSTIFICATION
9
Background Justification Aims
Participants/Methods Results Discussion
• Use of the CARAT questionnaire allows a closer and more
frequent approach, since symptoms involving asthma can
change
“…asthma severity involves both the severity of the underlying
disease and its responsiveness to treatment and may change
over months or years.”
15. Toshiro Shirai, Kazuki Furuhashi, Takafumi Soda, Kingo Shida, “Relatioship of the Asthma Control Test with pulmonary
function and exhaled nitric oxide,”Annals of Allergy, Asthma and Immunology”, vol 101 December 2008
JUSTIFICATION
10
Backgroun
d
Justification Aims
Participants/Methods
Results Discussion
• A greater use of the CARAT questionnaire combined with
other tests could decrease medical costs and increase life
quality
AIMS
11
Background Justification Aims
Participants/Methods Results
Discussion
• Evaluate the correlation between CARAT questionnaire and
lung function test results in adults suffering from both asthma
and rhinitis, and who have done both tests;
-Speculate about possible reasons for disparities between CARAT and
LFT results;
•Assess whether a specific lung function test variable
(%PredFEV1) is directly related to CARAT results;
-Explain the reasoning behind possible findings.
PARTICIPANTS/METHODS
12
Background Justification
Aims Participants/Methods Results Discussion
1. PARTICIPANTS:
1.1 CHARACTERISTICS:
• Asthma and Rhinitis (or Asthma) patients from “Centro Hospital
do Porto”;
- Male and Female;
- Over 18 years;
- Able to read and fill in the questionnaire;
- Had undertaken the Spirometry Test around the same time
they had answered the CARAT questionnaire.
PARTICIPANTS/METHODS
13
Background Justification Aims Participants/Methods
Results Discussion
2. METHODS:
THIS STUDY IS:
Observational
Cross Sectional
PARTICIPANTS/METHODS
14
Background Justification Aims
Participants/Methods Results
Discussion
2.1 DATA COLLECTING:
• Data retrieved from the Immunoallergology service’s Doctor’s
Suport System (SAM) of the São João Hospital during the period
of February- July 2011. Diseases shown were diagnosed in person
by the physician. Both plain text medical history files and ICD-9coded diagnoses were used. In some cases, information was
missing;
• We had access to variables such as: age, gender, weight, height,
diagnosis (asthma and/or rhinitis), atopy and also the scores
obtained in the CARAT and Lung Function Tests.
PARTICIPANTS/METHODS
15
Background Justification Aims
Participants/Methods Results
Discussion
2.1.1 Variables:
CARAT questionnaire
Lung Function Tests
-Upper airway scores
- Lower airway scores
- Global Score
- % Pred FEV1 and % FVC
- FEV1/FVC;
- Spirometry Classification
- % Pred FeNO and FeNO %
Predicted Classes
- Broncodilation
PARTICIPANTS/METHODS
16
Background Justification Aims
Participants/Methods Results
Discussion
2.2 SELECTED DATA:
2.2.1 Statistic Studies
• Patients were excluded according to the flowchart;
• The selected data underwent statistic treatment using IBM SPSS 20:
- Statistical analysis included Pearson correlations between different
values;
-Correlations were assessed for statistical significance (p<0,05);
- Results were represented in graphs and charts.
17
Flowchart 1 – Inclusion/exclusion criteria
RESULTS
18
Background Justification Aims
Participants/Methods
Results
Discussion
Table 1: Demographic data from the population in our
study
PARTICIPANTS/METHODS
19
Background Justification Aims
Participants/Methods Results
2.2.3 Correlations:
•CARAT lower airway and %Pred FEV1;
•Global score CARAT and %Pred FEV1;
•CARAT upper airway score and % Pred FEV1;
Discussion
RESULTS
20
Background Justification Aims
Participants/Methods
Results
Discussion
*N=319
Pearson’s
correlation
coefficient:
0,205
Significance:
P<0,001
Graph 1: Correlation between CARAT lower airway score and %Pred FEV1
RESULTS
21
Background Justification Aims
Participants/Methods
Results
Discussion
*N=319
Pearson’s
correlation
coefficient:
0,078
Significance:
P=0,164
Graph 2: Correlation between Global CARAT score and %Pred FEV1
RESULTS
22
Background Justification Aims
Participants/Methods
Results
Discussion
*N=319
Pearson’s
correlation
coefficient:
-0,138
Significance:
P=0,013
Graph 3: Correlation between CARAT upper airway score and %Pred FEV1
DISCUSSION
23
Background Justification Aims Participants/Methods
Results Discussion
1. GLOBAL CARAT SCORE AND %PRED FEV1:
• Non-significant;
• Patients with controlled asthma and rhinitis didn’t have a
better result in their %Pred FEV1 value;
As expected, the results of the correlation between the Global
CARAT Scores (concerning rhinitis) and the spirometry results were
not significant.
DISCUSSION
24
Background Justification Aims Participants/Methods
Results Discussion
2. CARAT UPPER AIRWAY SCORES AND%PRED FEV1:
• Significant (p=0.013);
• Negative correlation coefficient(-0.138);
•Unexpected result. Correlation was done with the intent of
displaying an absence of relationship between the two variables;
•Suggests that a higher control score regarding rinitis would imply
a lower spirometry result;
DISCUSSION
25
Background Justification Aims Participants/Methods
Results Discussion
2. CARAT UPPER AIRWAY SCORES AND%PRED FEV1:
• Relation was opposite to what would be expected, even in case
of improper separation of the questionaire scores, which we
thought would lead to a positive correlation between upper
airway scores and LFT results, suggesting that asthma and rhinitis
could not be separated);
• May be due to an unaccounted for confounding parameter.
DISCUSSION
26
Background Justification Aims Participants/Methods
Results Discussion
2. CARAT LOWER AIRWAY SCORES AND%PRED FEV1:
• Significant (p≺0,001);
• Correlation coefficient was quite low;
• The degree to which the variation in CARAT's scores explains the
variation in %PredFEVI is only 4%;
• The fact that asthma control may be influenced by many factors,
such as stress, allergies, could explain these low values
DISCUSSION
27
Background Justification Aims Participants/Methods
Results Discussion
• We have strong evidence to suggest that CARAT scores are
properly separated, although there are no studies that prove so,
since the Lower Airway Score has a much stronger and much more
significant correlation (p<0,001) with lung function test results than
the global CARAT scores, which had a near null coefficient, and a
non-significant p value(P=0,164).
• This is further supported by the fact that lower airway scores
behaved similarly to past attempts at similar approaches, such as the
ACT (Asthma Control Test).
DISCUSSION
28
Background Justification Aims Participants/Methods
Results Discussion
• For future studies, a more detailed research about the negative
correlation found between the results of the upper airway CARAT
scores and %PredFEV1 could be done with the intent of finding if
there is actually an unexpected correlation, or if it was just due to the
complications of this study;
• Concerning future research into the correlation between CARAT
Scores and %PredFEV1, we believe that, in future studies, an
increased number of participants may attenuate the confounding
parameters mentioned (stress, allergies…).
References
29
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of the Childhood Asthma Control Test and Objective Parameters in Asthmatic Children” J Asthma. 2011 Nov 2. [Epub
ahead of print]
Adams, R. J., D. H. Wilson, et al. (2004). "Psychological factors and asthma quality of life: a population based study."
Thorax 59(11): 930-935
Ruiz Aguirre J, Vilert Garrofa E, Solanas Saura P, Morera Jordán C, Mallorquí Beltrán C, Mas Marqués M. “Costs of
spirometry as a screening test for chronic obstructive pulmonary disease in primary care” Aten Primaria. 2005 Oct
31;36(7):373-7
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E Bateman, L Boulet, A Cru, M FitzGerald, T Haahtela, M Levy, P O’Byrne, K Ohta, P, Paggiaro, S Pedersen, M SotoQuiro, G Wong, N Barnes, P Barnes, A Becker, J Drazen, R Lemanske, E Pizichini, H Reddel, S Sullivan, S Wenzel –
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function and exhaled nitric oxide,”Annals of Allergy, Asthma and Immunology”, vol 101 December 2008
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26. Miguel Domingues, Control of Allergic Rhinitis and Asthma Test (CARAT): its applicability in assessment of asthma control
in adult subjects without rhinitis,ECS Universidade do Minho 2011
27. António Bugalho de Almeira, João A. Fonseca, Mário de Almeida, Ana Todo-Bom ETAL, Inquérito Nacional sobre a Asma
(INASma),
Dezembro
2010
Faculdade de Medicina da Universidade do Porto
32
Alexandra Azevedo
Ana Mafalda Neves
Bárbara Oliveira
Caroline Lopes
Joana Ribeiro
José Pedro Barbosa
Maria Beatriz Sampaio
Maria Luísa Vieira
Paulo Santos
Regina Silva
Rodrigo Andrade
Rui Ananias Gonçalves
25 de Maio de 2012
Turma 19
ACKNOWLEDGEMENTS
33
We would like to thank
Prof. Dr. João Fonseca,
Prof. Dr. Altamiro da Costa Pereira,
Ana Margarida Pereira,
Daniela Linhares
for the help given and time expended in our study.
25 de Maio de 2012