The Korean Version of the Test for Respiratory and Asthma Control in Kids (TRACK): Reliability and Validity

BACKGROUND: Test for Respiratory and Asthma Control in Kids (TRACK) questionnaires were developed and validated in various languages to monitor respiratory control in preschool-aged children. We aimed to assess the reliability and validity of the Korean version of the TRACK questionnaire. METHODS: We administered the linguistically validated TRACK questionnaires to caregivers of asthmatic preschool children on two separate visits 4–6 weeks apart. Each physician graded the level of the guideline-based asthma control, assessed the timing of symptoms, and adjusted the therapeutic level at each visit. RESULTS: A total of 137 children were enrolled in the study. Cronbach's alpha was 0.65 for a questionnaire as a whole. The test-retest reliability was 0.72. The median TRACK scores were significantly different between asthma control status categories, with the lowest scores in children classified as poorly controlled and the highest in the well-controlled group (P < 0.001). They were different among groups classified according to the physician adjusted therapeutic levels, with the lowest values in children prescribed step-up therapy (P < 0.001), and according to the recency of respiratory symptoms (P < 0.001). Finally, the changes in TRACK scores between visits were highest in subjects showing improved control, followed by unchanged, and worsened control. When we applied the traditional cut-off of 80 for a well-controlled condition, a sensitivity of 75.6% and a specificity of 70.9% were calculated. CONCLUSION: The Korean translated version of the TRACK questionnaire is valid and reliable to assess respiratory and asthma control in Korean preschool children with asthma symptoms.

A Case of Cycloserine-Induced Lichenoid Drug Eruption Supported by the Lymphocyte Transformation Test

Lichenoid drug eruption (LDE) is a rare form of delayed-type drug eruption. Among anti-tuberculosis (Tb) agents, cycloserine (CS) has been reported as a rare cause of LDE. Positive results on the lymphocyte transformation test (LTT) have not been reported in patients with LDE. In the present case, we performed LTT and a patch test, and successfully proved CS as the offending drug in this patient, who had been treated with multiple anti-Tb drugs. These observations suggest that CS should be considered a possible cause of LDE and that LTT can be an option for the diagnosis of LDE.

Improvement of tetanus prophylaxis by introducing an immunization information system

Tetanus immunoglobulin (TIG) and tetanus vaccination are in general use for tetanus prophylaxis in patients with trauma based on their personal history of tetanus vaccinations. However, the conventional injection of only TIG has been used for tetanus prophylaxis due to difficulties in verifying the known vaccination histories of Korean patients. We evaluated the effect of introducing an immunization information system (IIS) on tetanus prophylaxis. TIG-injected trauma patients (≥20 years old) who were registered at a single hospital from January 1, 2013 to December 31, 2015 were enrolled in this study. IIS was introduced to all doctors in that hospital starting on January 1, 2015. IIS information and medical records were used to assess histories of tetanus vaccination and TIG administration. Comparisons were made between the number of tetanus and TIG shots (inadequate TIG administrations) given before and after the introduction of the IIS. The number of TIG-injected patients varied during the study period (362 in 2013, 387 in 2014, and 235 in 2015). The proportion of tetanus-vaccinated patients relative to TIG-injected patients increased from 2.21% in 2013 to 4.13% in 2014 and 44.26% in 2015 (P <0.001). The proportions of cases that were recorded as having received inadequate TIG administration decreased from 3.59% (13 of 362) in 2013 for patients with ≥3 tetanus vaccinations to 4.39% (17 of 387) in 2014 and 1.28% (3 of 235) in 2015 for the same group P = 0.043). The introduction of IIS could increase the number of patients with trauma who have proper tetanus vaccinations and decrease the number who undergo inadequate TIG administrations. The introduction of IIS can improve clinical practice in terms of enhancing proper tetanus prophylaxis for appropriate patients.

Translation and linguistic validation of Korean version of the Test for Respiratory and Asthma Control in Kids instrument

PURPOSE: We aimed to translate the Test for Respiratory and Asthma Control in Kids (TRACK) instrument into Korean, with subsequent linguistic validation. METHODS: The multistep process of forward translation, reconciliation, back-translation, cognitive debriefing, and proofreading of the Korean version of the TRACK was completed. RESULTS: Two bilingual medical personnel independently translated the original English version of the TRACK into Korean one. After moderating the translation into a single reconciled one, 4 other bilingual persons were invited to translate the Korean draft back into an English one. Discrepancies between the original English version and the back-translated one were reviewed, and the need to modify the reconciled Korean draft was discussed. Twenty caregivers of asthmatic children took part in interviews that examine the appropriateness of the Korean version of the TRACK. The feedback from caregivers were then reviewed by a panel of pediatric allergists and reflected in the final Korean version. The document was finally proofread to check the spelling, grammar, layout and formatting. CONCLUSION: Translation and linguistic validation of the Korean version of the TRACK instrument were completed.

Phenotype and endotype in pediatric asthma

Asthma is not a homogeneous disease presenting variable clinical features, but a complex disorder consisting of many different disease entities characterized by variable air-flow limitation. To date, there are little effective preventive-strategies for the development of asthma, and it has been emphasized that early identification and intervention are the best ways to reduce the associated morbidities, quality of life, and socioeconomic burden. Predicting the natural course of asthma is still difficult, although various phenotypic approaches and predictive scores are developed and widely used. The present phenotypes and predictive scores may be reliable in the population, but those appear to be unreliable in each individual in real practice. Either undertreatment or overtreatment in childhood asthma is an important issue, because they are associated with poor compliance, increments of socioeconomic burdens, and poor quality of life. There is no doubt about the clinical efficacy of inhaled corticosteroid (ICS) in childhood asthma, but the negative effect of long-term use of ICS on the height is emerging. Therefore general physicians should consider an individualized management using specific phenotypes and endotypes, and regularly re-evaluate the drug-response, level of control, and adherence/compliance to avoid inadequate treatment.