Test for Respiratory and Asthma Control in Kids (TRACK)
Asthma is one of the most common chronic illnesses of childhood and a leading cause of activity
limitation, hospitalizations, and medical costs with children 1-4. Per the 2006 CDC report
approximately 5-6% of children 0-4 years of age have a diagnosis of asthma and estimates of up to
80% of children aged 5-18 with asthma are believed to have developed symptoms before age 5.
It is acknowledged that the prevalence of asthma in young children is underestimated. Several factors
contribute to the under diagnosis of asthma and improper control of asthma in early childhood. First,
no single diagnostic test for asthma exists, regardless of age, and those tests that are used to assess
lung function in older children, such as spirometry or exhaled nitric oxide, are not feasible to
administer to preschool aged children. Several techniques do exist that assess lung function in
preschool aged children, however these techniques are labor intensive, lack normative values for
interpreting results, and in some cases require sedation of the young child. Second, physicians are
more reluctant to give a diagnosis of asthma even when a preschool aged child presents several risk
factors and responds well to treatment since they may outgrow these symptoms in later years. In
addition, the same symptoms are commonly seen across many other indications including chronic
sinusitis, abnormal tracheal cartilage, and gastro esophageal reflux disease (GERD), which require
different courses of treatment than asthma. Lastly, because objective tests are not useful and the
respiratory symptoms that the child presents can mimic other conditions physicians must rely on the
history of the present illness being treated and the past medical history of the child and parents, which
adds to the challenge of diagnosing asthma in children under the age of five.
The Test for Respiratory and Asthma Control in Kids (TRACK) questionnaire tool was developed by
AstraZeneca, with the assistance of QualityMetric (QM), as a response to a consensus among
physicians and parents/caregivers that a standardized questionnaire completed by parents/caregivers
could be useful in assessing and monitoring respiratory control problems in preschool aged children.
To obtain cross validation of the TRACK questionnaire, general pediatricians collected data in
anticipation of providing secondary evidence of the reliability and validity of this now shortened
questionnaire. Additionally, these physicians evaluated its capability in screening for patients with
respiratory control problems as well as provided qualitative feedback on the shortened questionnaire.
A longitudinal component provided opportunity to evaluate the responsiveness of the questionnaire to
changes in respiratory control status.
1. Mannino DM, Homa DM, Pertowski CA, et al. Surveillance for asthma-United States, 1960-1995. MMWR Morb Mortal Wkly
2. Centers for Disease Control and Prevention. Asthma mortality and hospitalization among children and young adults: United
States, 1980-1993. JAMA 1996;275:1535-1537.
3. Newacheck PW, Halfon N. Prevalence, impact and trends in childhood disability due to asthma. Archives of Pediatric and
Adolescent Medicine 2000;154:287-293.
4. Weiss KB, Sullivan SD, Lyttle CS. Trends in the cost of illness for asthma in the United States, 1985-1994. Journal of Allergy and
Clinical Immunology 2000;106:493-499.
The aim of this project was cross validation of a paper-based questionnaire designed to improve the
identification of pre-school age children (age 4 and under) at risk for respiratory control problems
based on National Institutes of Health indicators.
Sites were selected on the basis of their experience in treating children with respiratory control
problems and on the physician’s knowledge of asthma treatment management guidelines. Within
each site, the TRACK questionnaire was administered to a target of 20 to 25 caregivers of young
children with current active respiratory problems, or a recent past history (in the last 12 months) of
respiratory problems. TRACK participants were required to complete a brief questionnaire to
provide an overall rating of each child’s level of respiratory control on a three-point Likert-type
rating scale. The caregivers were then required to complete a self-administered questionnaire while
in the physician’s office. The caregiver questionnaire was designed to assess the child’s risk of
persistent respiratory control problems and current level of respiratory control. For each item of the
questionnaire, caregivers were asked to rate the frequency and intensity of their child’s respiratory
symptoms, the frequency of any activity limitations due to respiratory problems, the impact of
respiratory problems on their child’s life, and use of rescue medication, during the past four weeks
using a Likert rating scale. In addition, caregivers were asked about the number of hospital stays,
emergency department visits, or unscheduled doctor visits that were made during the past three
months for their child’s respiratory problems.
Both the physician questionnaire and the caregiver questionnaire was administered twice, 4-6 weeks
apart. This time interval enabled us to assess the responsiveness of the TRACK questionnaire to
changes in respiratory control and symptoms, as well as to assess the test-retest reliability of the
TRACK questionnaire in a subset of “stable” patients who show no changes in respiratory control or
symptom status from the baseline to follow-up assessments.
Timeline for Participating Sites
Assemble study Recruit 20-25
team and caregivers who Complete and return
participate in meet the study TRACK-Physician
training with the inclusion/ Surveys and TRACK surveys
TRACK staff exclusion Caregiver Surveys
Assess progress at regular Return follow-up TRACK-Physician Surveys
intervals with TRACK staff and TRACK Caregiver Surveys to the QM
Central Study Coordinator
All applications received were reviewed by the TRACK Project Team. A broad range of practice
settings, and patient populations were considered as well as previous experience in quality
improvement projects. Applicants were expected to have identified a team and documented in the
application the commitment of lead physician to support this project.
The first 25 practices to apply and meet criteria to participate were selected into the study.
Benefits of Participation
We believe there were several benefits for participants involved in this cross-validation study.
Teams had the opportunity to:
Learn how to better identify pre-school age children at risk for respiratory control
problems based on National Institutes of Health indicators. If improvements are made in
screening, children will be identified with respiratory control problems earlier, which may
lead to better health and developmental outcomes.
Provide verbal input on the TRACK questionnaire prior to its dissemination nationally.
Participate in an evaluation of the TRACK tool’s responsiveness to changes in respiratory
Offer caregivers who participate through the follow-up visit remuneration of $50 to be
paid by the study.
Receive remuneration to the site of $75 for each patient who completes the study, as
reimbursement for your time spent in the follow-up visit. Payment will be issued by AAP
at the conclusion of the project.
Specific Expectations and Time Commitment
Commitment to participate and make improvements in the identification of pre-school age
children (age 4 and under) at risk for respiratory control problems using the TRACK
Commitment to view a 30-minute video training course on asthma treatment according to the
NIH management guidelines, and complete a brief test to earn a passing score of 80% of
questions correctly answered.
Identification and participation of a 2 to 3 person multidisciplinary team (we suggest primary
care physician, nurse, and administrative level person) for approximately 2 months. This
Participate in study training via Web-X and teleconference calls soon after selection to
review in detail the data collection requirements.
Utilize the screening checklist to enlist into the study 20-25 caregivers of children 0-4
years of age with current active respiratory problems, or a recent past history (in the
last 12 months) of respiratory problems.
Ensure that each caregiver reads, understands, and signs an informed consent form.
Distribute to each caregiver the paper-based TRACK Cross Validation Questionnaire –
Caregiver Survey, and ensure it is completed in the TRACK participant’s office/clinic.
Complete the TRACK Cross Validation Study Questionnaire – Physician Survey for
each child/caregiver enlisted by the site.
Record the date and reason for the physician office visit, and physician ratings of
control and change in therapy in the source documents.
Mail and/or fax the completed surveys back to a designated QM central study
coordinator site within one-week of the survey being completed.
Schedule a follow-up visit (4-6 weeks after the initial visit) with the caregiver and
child, during which the caregiver will complete the TRACK Cross Validation
Questionnaire – Caregiver Survey.
Complete the TRACK Cross Validation Study Questionnaire – Physician Survey for
each child/caregiver enlisted by the site at the follow-up visit.
Participate in monthly calls with the TRACK Project Team to provide feedback on the
tool and process in general
Institutional Review Board (IRB)
The TRACK project has received approval from the AAP Institutional Review Board. No identifiable
protected health information is being collected for this project; therefore, HIPAA authorization will
not be needed from patients in order for your practice to participate. Given the limited timeframe
designated for this study, preference will be given to applicants who do not require local IRB
approval in addition to AAP IRB.