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Asth ma attacks can be stressful for both children and parents. Beyond the immediate symptoms, they can lead to missed school days, emergency room visits, and even hospital stays. What many parents don’t realize is that one asthma attack can increase the risk of future ones — but by knowing the warning signs and tracking your child’s lung health, you can take steps to reduce that risk and prepare for an attack. Children who have Repeat Asthma Attacks Research shows that children who have had an asthma attack are more likely to have another one within the next year — about a 25% higher chance (1, 2). Similarly, the more times a child is hospitalized for asthma, the greater the likelihood of another hospital visit down the line (1). One of the key predictors of future asthma problems is a measure called FEV₁ — or forced expiratory volume in one second. It’s a way to see how much air your child can breathe out quickly after taking a deep breath. (Learn what the spirometry lung function measures mean here ) In one study, researchers found that a 10% drop in FEV₁ over three months increased the risk of another asthma flare-up by 28% in the next three months (1, 3). It also meant poor asthma control was more likely (3). Other studies have shown that when FEV₁ levels are below 80% of what’s expected for a child’s age and size, the risk of another asthma attack increases significantly (4). This risk is even greater for FEV 1 less than 60% of the predicted value (4). In other words, even a single lung function test can help predict asthma risks for months — or even years — ahead (5). Another helpful measure is the mid-ma ximal expiratory flow (MMEF), also known as forced expiratory flow25-75% (FEF25 - 75%) . This number represents the average airflow during the middle 50% of a spirometry test. It gives doctors more detail about how well the smaller airways are working (6). One study found that a low MMEF was linked to a higher number of asthma attacks in the following year , making it another valuable tool for predicting which children might be at greater risk (7). What Parents Can Do 1. Monitor Lung Function at Home with SPARKY TM Keeping track of your child’s lung function can help you spot early signs that asthma may be worsening — before symptoms become serious. SPARKY TM lets you measure important lung function values such as FEV₁ and MMEF at home. This gives you and your child’s doctor valuable information to adjust treatment early and prevent an attack. 2. Watch for Changes in Symptoms If your child’s coughing, wheezing, or shortness of breath seems to be getting worse, even slightly, it’s worth noting. Small changes can signal that their asthma is becoming less controlled (8). Keep on top of changes by using the ACT and TRACK surveys regularly (See our blogs for more information). 3. Stick to the Asthma Action Plan Every child with asthma should have a written plan from their healthcare provider. Make sure you know when to give daily medications, when to use a rescue inhaler, when to step up medications and when to seek emergency care (8, 9). 4. Follow Up Regularly Regular checkups — even when your child feels fine — help doctors track trends in lung function and adjust treatment as needed (8). The Bottom Line Asthma attacks don’t have to come as a surprise. By staying aware of your child’s lung function and understanding the risk factors for flare-ups, you can take proactive steps to keep their asthma under control — and help them breathe easier every day. Sarikloglou E , Fouzas S , Paraskakis E . Prediction of Asthma Exacerbations in Children. Journal of Personalized Medicine 14: 20, 2024. doi: 10.3390/jpm14010020. McIntyre A , Busse WW . Asthma Exacerbations: The Achilles Heel of Asthma Care. Trends Mol Med 28: 1112–1127, 2022. doi: 10.1016/j.molmed.2022.09.001. Fielding S , Pijnenburg M , de Jongste JC , Pike KC , Roberts G , Petsky H , Chang AB , Fritsch M , Frischer T , Szefler S , Gergen P , Vermeulen F , Vael R , Turner S . Change in FEV1 and Feno Measurements as Predictors of Future Asthma Outcomes in Children. Chest 155: 331–341, 2019. doi: 10.1016/j.chest.2018.10.009. Kitch BT , Paltiel AD , Kuntz KM , Dockery DW , Schouten JP , Weiss ST , Fuhlbrigge AL . A Single Measure of FEV1 Is Associated With Risk of Asthma Attacks in Long-term Follow-up. CHEST 126: 1875–1882, 2004. doi: 10.1378/chest.126.6.1875. Fuhlbrigge AL , Kitch BT , Paltiel AD , Kuntz KM , Neumann PJ , Dockery DW , Weiss ST . FEV1 is associated with risk of asthma attacks in a pediatric population. Journal of Allergy and Clinical Immunology 107: 61–67, 2001. doi: 10.1067/mai.2001.111590. Lazova S , Priftis S , Petrova G , Naseva E , Velikova T . MMEF25-75 may predict significant BDR and future risk of exacerbations in asthmatic children with normal baseline FEV1. Int J Physiol Pathophysiol Pharmacol 14: 33–47, 2022. Chereches-Panta P , Marica I , Sas V , Bouari-Coblișan AP , Man SC . The Role of Spirometry and MMEF in Pediatric Asthma Monitoring and Prediction of Exacerbations. Children 12: 1398, 2025. doi: 10.3390/children12101398. Asthma Attacks [Online]. Asthma Canada: [date unknown]. https://asthma.ca/get-help/living-with-asthma/asthma-attacks/ [4 Nov. 2025]. Asthma attack - Diagnosis and treatment - Mayo Clinic [Online]. [date unknown]. https://www.mayoclinic.org/diseases-conditions/asthma-attack/diagnosis-treatment/drc-20354274 [4 Nov. 2025].

Managing asthma isn’t just about treating symptoms when they appear — it’s about understanding how well your asthma is controlled over time and if your child’s asthma is getting worse. Two powerful tools that help both patients and healthcare providers track asthma control are the Asthma Control Test (ACT) and the Test for Respiratory and Asthma Control in Kids (TRACK) . These short surveys take less than 5 minutes to complete and offer valuable insights that can guide treatment, improve communication, and ultimately help prevent asthma flare-ups. What is the Childhood Asthma Control Test (C-ACT)? The ACT is a quick survey designed for children a ged 4-11 . It includes 3 parent-reported and 4 child-reported questions that cover symptoms, activity limitations, and overall control over the past four weeks (1). Child-reported questions are scored from 0 to 3 while parent-reported questions are scored from 0-5. Higher scores represent better asthma control while a final score ranges between 0 and 27 . A total score of 19 or less is considered to represent inadequately controlled asthma (1, 2). Patients and parents can complete the C-ACT in just a few minutes, either on paper or electronically. Clinicians use the score to assess whether a current treatment plan is effective or if adjustments are needed. The link to the C-ACT survey can be found here . What is the Test for Respiratory and Asthma Control in Kids (TRACK) Survey? For children aged 4 or less , who often can’t describe their symptoms accurately, the TRACK is used. This is a 5-question survey that assesses asthma risk and impairment using answers from parents and caregivers to evaluate asthma control (3). This 5-question tool focuses on: Frequency of respiratory symptoms (like coughing or wheezing) Nighttime awakenings Use of quick-relief medications Activity limitations Episodes requiring oral steroids Each question is scored from 0 to 20, for a total out of 100. With a score of 80 or higher, Asthm a is considered well controlled. A score of b elow 80 means Asthma may not be well controlled, and a healthcare review is advised. TRACK is particularly helpful for young children who are just beginning asthma management or whose symptoms fluctuate with viral infections or seasonal changes. The link to the TRACK survey can be found here . Why These Tools Matter Both ACT and TRACK surveys turn subjective experiences into trackable data . They empower families and patients to play an active role in asthma management and help providers make evidence-based decisions. By regularly completing these assessments—often at every check-up or every few months—you can: Detect worsening control before symptoms become severe Evaluate how well current medications are working Foster better communication between patients, families, and providers Support shared decision-making in care plans Using ACT and TRACK at Home Many clinics offer these surveys during appointments, but they can also be completed at home. Online versions and printable PDFs are widely available through organizations such as the Lung Health Foundation, American Lung Association and Asthma and Allergy Foundation of America . Bringing your completed ACT or TRACK results to your next appointment helps your provider fine-tune your care plan and reduce the risk of asthma attacks. The Bottom Line The ACT and TRACK surveys are more than just questionnaires—they’re powerful tools for proactive asthma care . Whether you’re an adult managing your own symptoms or a parent monitoring your child’s breathing, quick check-ins give you a snapshot of the current situation. Staying consistent with these assessments can help ensure fewer flare-ups, better daily living, and greater confidence in managing asthma long-term. Combined with objective metrics such as spirometry, these tools can make a big difference in understanding and controlling asthma. Bime C , Gerald JK , Wei CY , Holbrook JT , Teague WG , Wise RA , Gerald LB . Measurement characteristics of the childhood Asthma-Control Test and a shortened, child-only version. NPJ Prim Care Respir Med 26: 16075, 2016. doi: 10.1038/npjpcrm.2016.75. Burbank AJ , Atkinson CE , Espaillat AE , Schworer SA , Mills K , Rooney J , Loughlin CE , Phipatanakul W , Hernandez ML . Race-specific spirometry equations may overestimate asthma control in Black children and adolescents. Respiratory Research 24: 203, 2023. doi: 10.1186/s12931-023-02505-3. Murphy KR , Zeiger RS , Kosinski M , Chipps B , Mellon M , Schatz M , Lampl K , Hanlon JT , Ramachandran S . Test for Respiratory and Asthma Control in Kids (TRACK): A caregiver-completed questionnaire for preschool-aged children. Journal of Allergy and Clinical Immunology 123: 833-839.e9, 2009. doi: 10.1016/j.jaci.2009.01.058.

Asthma is the most prevalent respiratory disease in children, affecting ~10% of children across the world (Global Asthma Report) (1). Therefore, assessing lung function in children is essential—especially for those showing signs of persistent coughing, wheezing, or shortness of breath. But when it comes to preschool-aged children (typically ages 3–5), evaluating their lung function isn't as straightforward as it is for older children and adults. One of the gold-standard tools in respiratory medicine, spirometry , is often unreliable in this age group. This gap poses a real challenge for clinicians and can delay the accurate diagnosis and management of conditions like asthma . Why Spirometry Doesn’t Work Well in Preschoolers Cooperation and Comprehension - Spirometry requires a child to Seal their lips tightly around a mouthpiece Take a deep breath in Blow out as hard and as fast as they can for several seconds This sequence is unnatural and therefore challenging for many preschoolers, who may not fully understand or follow instructions consistently (2, 3). The result? Inaccurate, incomplete, or unreliable data . Poor Reproducibility Even if a young child manages to perform the test once, repeating it with the same effort and technique is a major hurdle. Reproducibility and therefore reliability is often lacking in this age group (3, 4). Lack of Normative Data Even when good-quality spirometry is achieved, there’s limited reference data for children under 6 (2). This makes it hard to interpret whether the results are truly normal or not. What Are the Consequences? The inability to perform reliable spirometry in preschoolers leads to several clinical consequences : Delayed or missed diagnosis : Without objective lung function data, diagnosing asthma or other lung diseases becomes more subjective and error-prone. Over-treatment or under-treatment : Children may be prescribed medications they don't need—or may not receive treatment they urgently require. Poor disease monitoring : Clinicians must rely more heavily on symptoms alone when the child has an appointment, which can be vague or misleading due to recall issues. Moving Forward: Bridging the Gap To improve respiratory care in preschoolers, we need: More research into child-friendly lung function tests Broader access to pulmonary function tests and tools that enable lung function tests in this age group Better training and protocols for performing spirometry in young children More normative data for interpreting results in this age group Final Thoughts The preschool years are a critical window for identifying and managing respiratory issues like asthma. Yet our tools for evaluating lung function aren’t always up to the task. While clinicians do their best with clinical judgment and symptom tracking, the lack of reliable objective testing in this age group remains a significant gap in paediatric respiratory care . Continued innovation, research, and advocacy are key to closing it. 1 Yuan L , Tao J , Wang J , She W , Zou Y , Li R , Ma Y , Sun C , Bi S , Wei S , Chen H , Guo X , Tian H , Xu J , Dong Y , Ma Y , Sun H , Lv W , Shang Z , Jiang Y , Lv H , Zhang M . Global, regional, national burden of asthma from 1990 to 2021, with projections of incidence to 2050: a systematic analysis of the global burden of disease study 2021. eClinicalMedicine 80, 2025. doi: 10.1016/j.eclinm.2024.103051. Fuhlbrigge AL , Kitch BT , Paltiel AD , Kuntz KM , Neumann PJ , Dockery DW , Weiss ST . FEV1 is associated with risk of asthma attacks in a pediatric population. Journal of Allergy and Clinical Immunology 107: 61–67, 2001. doi: 10.1067/mai.2001.111590. Aurora P , Stocks J , Oliver C , Saunders C , Castle R , Chaziparasidis G , Bush A . Quality Control for Spirometry in Preschool Children with and without Lung Disease. Am J Respir Crit Care Med 169: 1152–1159, 2004. doi: 10.1164/rccm.200310-1453OC. Nève V , Edmé J , Devos P , Deschildre A , Thumerelle C , Santos C , Methlin C , Matran M , Matran R . Spirometry in 3–5‐year‐old children with asthma. Pediatric Pulmonology 41: 735–743, 2006. doi: 10.1002/ppul.20389.

It’s been well-documented that racial and ethnic disparities exist across many areas of healthcare. In recent years, however, the focus has begun to shift—from simply recognizing these disparities to actively addressing them. Nowhere is this more critical than in the tools and practices we use to diagnose and manage disease. One such tool is the pulmonary function test (PFT), a standard test used to assess how well the lungs work (1). For over a decade, major medical organizations—including the American Thoracic Society (ATS)—have recommended using race- and ethnicity-specific reference equations to interpret these tests. The idea was to “normalize” expected lung function based on the patient’s racial or ethnic background (2, 3). But this approach has a major flaw: race is a social construct, not a biological one. By embedding race into the very algorithms we use for diagnosis, we risk reinforcing the very disparities we're trying to dismantle. The Problem with Race-Specific Equations Using race-specific equations in pulmonary testing can unintentionally normalize lower lung function values in certain populations—particularly Black individuals. This can lead to underdiagnosis or delayed treatment of pulmonary conditions like asthma or COPD. In fact, it wasn’t until 2022 that the Global Lung Function Initiative (GLI) released race-neutral average reference equations (GLI-Global and GLI-Other), and it was only in 2023 that the ATS and the European Respiratory Society (ERS) formally recommended transitioning to these updated equations (2). What the Research Shows A study by Rosenfeld and colleagues explored what happens when we stop adjusting pulmonary test results for race. They found that using the GLI-Global equations led to a higher average ppFEV1 (percent predicted forced expiratory volume in one second) in White patients (+4.6%) and a lower ppFEV1 in Black patients (-7.7%) (2). This is significant. The decline seen in Black patients with the race-neutral model suggests that prior race-specific equations may have underestimated the severity of lung disease in this population (2). What was once considered "normal" for Black patients may have, in fact, masked serious illness (2). Similarly, a study by Burbank and colleagues found that applying race-neutral spirometry equations led to more children being classified with uncontrolled asthma (ppFEV1 < 80%)—regardless of whether their asthma control test (ACT) labelled them as controlled (ACT >19) or uncontrolled (ACT ≤19). Among children with controlled asthma (measured by ACT score >19), those who shifted from “controlled” (≥80%) to “uncontrolled” (<80%) lung function also had significantly lower FEV1/FVC ratios, indicating worse airway obstruction (3). What This Means for Health Equity These findings highlight a stark reality: race-specific equations, though well-intended, may perpetuate disparities by obscuring the true burden of disease in certain racial and ethnic groups (2, 3). Shifting to race-neutral reference equations is not just a technical correction—it’s a step toward more equitable healthcare. It allows us to detect disease earlier, treat it more effectively, and ensure that our diagnostic tools do not unintentionally reflect or reinforce systemic biases. The Road Ahead As the medical community continues to reevaluate long-standing practices, it’s vital to center health equity in our decisions. The adoption of race-neutral equations in pulmonary function testing is a powerful example of how evidence-based updates can drive more just and inclusive care. While this transition is still unfolding, it represents meaningful progress in aligning science with social responsibility—and in ensuring that all patients, regardless of race, receive the care they truly need. Lung Function Tests [Online]. American Lung Association: [date unknown]. https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/lung-function-tests [7 Oct. 2025]. Rosenfeld M , Cromwell EA , Schechter MS , Ren C , Flume PA , Szczesniak RD , Morgan WJ , Jain R . The impact of switching to race-neutral reference equations on FEV1 percent predicted among people with cystic fibrosis,. Journal of Cystic Fibrosis 23: 443–449, 2024. doi: 10.1016/j.jcf.2024.03.013. Burbank AJ , Atkinson CE , Espaillat AE , Schworer SA , Mills K , Rooney J , Loughlin CE , Phipatanakul W , Hernandez ML . Race-specific spirometry equations may overestimate asthma control in Black children and adolescents. Respiratory Research 24: 203, 2023. doi: 10.1186/s12931-023-02505-3.

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