The authors have disclosed no conflicts of interest. The ACQ has 7 questions: 5 related to symptoms, 1 to beta2-agonist use, and 2 related to FEV1 (completed by clinic staff). Also, the ATAQ score of 3 or greater is the defined cutoff for the NAEPP EPR-3 category of “very poorly controlled” asthma.4. Know your score. Inflammation Biomarkers in the Assessment and Management of Severe Asthma – Tools and Interpretation: This document was developed by the Centre of Excellence in Severe Asthma. This review examines the tools that have established psychometric properties and have been extensively studied in terms of their content or domains, methods of administration, and ability to reflect the overall status of asthma control. Correspondence: Ellen A Becker PhD RRT-NPS RPFT AE-C FAARC, Rush University, Armour Academic Center, Suite 750, 600 South Paulina Street, Chicago, IL 60612. Asthma Quality of Life Questionnaire (AQLQ). Similar to other diseases, control of asthma involves control of (1) current impairment, including daily/nocturnal symptoms, reliever use, level of activity, and quality of life, and (2) future risk, including the risk of exacerbations, permanent impairment of lung function, and the adverse effects of treatment. The total scores were lower after resolution of asthma exacerbation compared with the scores during the exacerbation. Also, the changes in the adult LASS scores had a weak correlation with the changes in the AQLQ scores (r = −0.70) and with the changes in percent-of-predicted FEV1 (r = −0.14).74. The ACT is a patient-centered/com- pleted questionnaire that recalls the patient’s experience of 5 items: asthma symptoms (nocturnal and daytime), the This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Although the design of the LASS specifies that a higher score indicates more symptoms, the cutoff values that distinguish between patients' different levels of asthma control have not been established. It provides an overview of fractional exhaled nitric oxide (FeNO) and eosinophil numbers as biomarkers to inform asthma management, including assessment approaches and interpretation of findings. Each item is scored on a 5-point scale with the descriptors: never, a few days, some days, most days, and every day. Despite their availability and widespread promotion, repeated audits … Take the Asthma Control TestTM (ACT) for people 12 yrs and older. The targeted patient age is another difference among tools. The user can then export it to show it to the doctor. Sign In to Email Alerts with your Email Address. Despite the fact that measures of lung function are infrequently performed because spirometry equipment is costly and is not always available,79 these measures are considered an essential criterion of asthma control in both the 2015 GINA and NAEPP EPR-3 guidelines.10 On the other hand, some of these tools evaluate asthma control concepts not included in the guidelines, such as the patient's perception of asthma control in the ACT, cACT, and ATAQ and specific asthma symptoms, such as shortness of breath in ACT, wheezing in the ACQ, and coughing and chest pain in the LASS. Characteristics of Asthma Control Assessment Tools. Although the ACQ was initially developed for adult patients with asthma, its ability to quantify asthma control level in children was evaluated as well. The Asthma control Test is a commonly used tool by healthcare providers globally, and has been scientifically tested with hundreds of people with asthma Your Answers Create Actionable Results The Asthma Control Test is a way to help you and your healthcare provider determine if your asthma symptoms are well controlled Aim: The mini AQLQ is closely related to the larger questionnaire and was developed to measure the functional impairments that are most troublesome to adult patients (17–70) as a result of their asthma. Respondents are graded as either having or not having a control problem in each one of these 4 items; the item scores are then summed to provide a total, which ranges from 0 (no asthma control problems) to 4 (4 asthma control problems).8,40,66,67 Skinner et al71 developed a parent completed ATAQ version to identify children and adolescents (5–17 y old) with current problems in asthma control. https://www.qoltech.co.uk/index.htm. This review examines the commonly used asthma control assessment tools in terms of content, psychometric properties, methods of administration, limitations, and ability to reflect the overall status of asthma control, which can aid clinicians in selecting the most appropriate tool for their needs. Nonetheless, considerable differences between them still exist. The minimum clinically important difference for ATAQ has not yet been established. Ideally, the complete 7-item ACQ should be used. Aim: The AQLQ was developed to measure the functional problems (physical, emotional, social, and occupational) that are most troublesome to adults (17–70 years) with asthma. Subsequently, responses for each of the 5 items are summed to yield a score ranging from 5 (poor asthma control) to 25 (complete asthma control).9, Overall validity of the ACT has been assessed more than any other asthma control assessment tool. Asthma Control Questionnaire (ACQ) Aim: To measure the adequacy of clinical asthma control. Despite the reported merits of these tools, they are not without shortcomings. Thus, omitting FEV1 as in ACQ-6b and in ACQ-5 could affect the possibility of using those 2 versions interchangeably with other versions of the ACQ. Methods As a component of a multidisciplinary assessment, adult patients referred with treatment‐refractory asthma underwent respiratory physiotherapy assessment to diagnose BPD. The cACT has been validated more than any other asthma control assessment tool for children with asthma, and, therefore, it has been designated as a core outcome for NIH-initiated participant characterization and for observational studies.37–40 In the developmental study, Liu et al36 reported that the cACT overall score discriminated between patients who differ in the specialists' rating of asthma control. Later, an adult version was developed. Schatz et al13 reported that changes in ACT scores were strongly correlated with changes in ACQ scores, moderately correlated with changes in specialist control ratings, and weakly correlated with change in percent-of-predicted FEV1 values. Management of acute exacerbation of asthma / wheeze primary care clinical assessment tool for children over two years (NHS England) NICE guidelines on management of asthma in children and young people Objective measurement of lung function is important in the diagnosis and assessment of acute and chronic asthma. The LASS had a high internal consistency in both adult and child populations. However, the 4 versions of ACQ had variable agreement when compared with the 2008 GINA and the NAEPP EPR-3 criteria for asthma control. In another study, Meltzer et al65 reported that with each point increase in the ACQ score, there is a 50% higher risk of exacerbations. Internal consistency and validity of the SF- 36 questionnaire, Validation and agreement across four versions of the asthma control questionnaire in patients with persistent asthma, Measurement properties and interpretation of three shortened versions of the asthma control questionnaire, The standardized and mini versions of the PAQLQ are valid, reliable, and responsive measurement tools. Relying solely on the role of lung function tests is insufficient to reflect the status of asthma control, since patients with asthma may have normal spirometry between exacerbations. DOI: https://doi.org/10.4187/respcare.04341, GINA Report, Global Strategy for Asthma Management and Prevention, Economic burden of asthma: a systematic review, National Asthma Education and Prevention Program, Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007, Erratum in: J Allergy Clin Immunol 2008;121(6):1330, Assessment of asthma control and severity, A new perspective on concepts of asthma severity and control, Evaluation of asthma control by physicians and patients: comparison with current guidelines, Clinical assessment of asthma symptom control: review of current assessment instruments, Development of the Asthma Control Test: a survey for assessing asthma control, Measuring asthma control is the first step to patient management: a literature review, Asthma control test and asthma quality of life questionnaire association in adults, Validation of a standardized version of the asthma quality of life questionnaire, Asthma control test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists, Development and validation of a questionnaire to measure asthma control, [Comparison of the Asthma Control Test (ACT) with lung function, levels of exhaled nitric oxide and control according to the Global Initiative for Asthma (GINA)], Asthma control test (ACT): comparison with clinical, functional, and biological markers of asthma control, Evaluation of the Asthma Control Test: a reliable determinant of disease stability and a predictor of future exacerbations, Validation of the Spanish version of the Asthma Control Test (ACT), Validity of Asthma Control Test in Chinese patients, Validation of the Arabic version of the Asthma Control Test, Validity and reliability evidence of the Asthma Control Test: ACT in Greece, Correlation between the Korean version of asthma control test and health-related quality of life in adult asthmatics, The asthma control test (ACT) as an alternative tool to global initiative for asthma (GINA) guideline criteria for assessing asthma control in Vietnamese outpatients, Quality of asthma care: results from a community pharmacy based survey, Validity of the Asthma Control Test completed at home, Reliability and predictive validity of the Asthma Control Test administered by telephone calls using speech recognition technology, Real-world evaluation of asthma control and treatment (REACT): findings from a national Web-based survey, Global strategy for asthma management and prevention: GINA executive summary, Monitoring childhood asthma: Web-based diaries and the asthma control test, The Asthma Control Test (ACT) as a predictor of GINA guideline-defined asthma control: Analysis of a multinational cross-sectional survey, Current asthma control predicts future risk of asthma exacerbation: a 12-month prospective cohort study, The association between asthma control and health care utilization, work productivity loss and health-related quality of life, Change in asthma control over time: predictors and outcomes, The relationship of asthma impairment determined by psychometric tools to future asthma exacerbations, The minimally important difference of the Asthma Control Test, Development and cross-sectional validation of the Childhood Asthma Control Test, Reliability and validity of Childhood Asthma Control Test in a population of Chinese asthmatic children, The Childhood Asthma Control Test: retrospective determination and clinical validation of a cut point to identify children with very poorly controlled asthma, Childhood Asthma Control Test and airway inflammation evaluation in asthmatic children, Asthma outcomes: composite scores of asthma control, Comparison of the Global Initiative for Asthma Guideline-based Asthma Control Measure and the Childhood Asthma Control Test in evaluating asthma control in children, Measuring quality of life in children with asthma, Measuring quality of life in the parents of children with asthma, Evaluation of a short form for measuring health-related quality of life among pediatric asthma patients, Clinical profile, health-related quality of life, and asthma control in children attending US asthma camps, Fractional exhaled nitric oxide and forced expiratory flow between 25% and 75% of vital capacity in children with controlled asthma, The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: systematic review and meta-analysis, Guidelines for management of asthma in adults: I. The ACT is a multidimensional, standardized, and validated tool and the most widely used tool for assessing asthma control in patients with asthma older than 12 y.8 Similar to most asthma assessment tools, the ACT quantifies asthma control as a continuous variable and provides a numeric value to distinguish between controlled and uncontrolled asthma. Integrating patient preferences into health outcomes assessment: the multiattribute Asthma Symptom Utility Index, Identifying “well-controlled” and “not well-controlled” asthma using the Asthma Control Questionnaire, Measurement of asthma control according to global initiative for asthma guidelines: a comparison with the asthma control questionnaire, Overall asthma control: the relationship between current control and future risk, Asthma and lower airway disease: use of the Asthma Control Questionnaire to predict future risk of asthma exacerbation, Association of asthma control with health care utilization and quality of life, Association of asthma control with health care utilization: a prospective evaluation, Extent, patterns, and burden of uncontrolled disease in severe or difficult-to-treat asthma, The ACT and the ATAQ are useful surrogates for asthma control in resource-poor countries with inadequate spirometric facilities, Evaluation of association between airway hyperresponsiveness, asthma control test, and asthma therapy assessment questionnaire in asthmatic children, The Asthma Therapy Assessment Questionnaire (ATAQ) for children and adolescents, Asthma control, severity, and quality of life: quantifying the effect of uncontrolled disease, An English and Spanish pediatric asthma symptom scale, Quantifying asthma symptoms in adults: the Lara Asthma Symptom Scale, Reliability and validity of a Chinese version of the Pediatric Asthma Symptoms Scale, Interpretative strategies for lung function tests, Determining a minimal important change in a disease-specific quality of life questionnaire, Asthma control measurement using five different questionnaires: a prospective study, http://www.ginasthma.org/local/uploads/files/GINA_Report_2015_Aug11.pdf. The review below addressed the validity, reliability, accuracy, and responsiveness of each tool. To assess the ability of the ACQ to predict future exacerbations, Bateman et al64 reported a marked increase in the risk of future exacerbations in subjects with ACQ-5 scores of ≥0.75 compared with subjects with ACQ-5 scores of <0.05. Also, a review by Halbert et al10 highlighted the discrepancy between the content of most of the tools and the national and international guidelines. Accurate assessment of asthma control is difficult due to the complexity of asthma control and due to the limitations in the traditional methods of assessment, such as lung function tests, physician assessment, and patients' self-assessment. Whereas the ACQ is scored using a 7-point scale, from 0 (totally controlled) to 6 (extremely poorly controlled), the ACT total score ranges from 5 (poor control of asthma) to 25 (complete control of asthma). The ATAQ was also used to assess the economic burden of uncontrolled asthma. However, a trained interviewer is required to administer the questionnaire to children 6–10 y old.53,54, The extensive validation data of the ACQ resulted in the ACQ being designated as a core measure for NIH-initiated clinical research in adults.40 The ACQ has been validated for use as a self-administered tool in-person, at home, or by telephone.40 Moderate to strong correlations resulted from comparing the ACQ with the AQLQ (r = 0.76),54 Mini Asthma Quality of Life Questionnaire (r = 0.72 and 0.74),55 the Medical Outcomes Survey Short Form-36 (SF-36) (r = 0.19–0.55),56 and the ACT (r = −0.82 to −0.89).13,14,19. Reliability concerns whether a tool is internally consistent or reproducible and, therefore, whether it consistently measures what it is intended to measure. The Asthma Guideline Implementation Steps & Tools (GIST) project was funded in 2010 by the National Asthma Control Initiative (NACI) to develop a program that makes it easier for primary care clinicians to use the NHLBI asthma guidelines in their everyday care of patients with asthma. For instance, in the United States, studies have included mostly white patients. Asthma continues to be a common disease associated with high mortality and high economic and social tolls despite the advances in the understanding of the pathophysiology of asthma, the availability of effective preventive therapy, and the availability of international treatment guidelines. Intended population: adults with asthma (17 years and older). You are about to begin the Knowledge Self-Assessment (KSA) for Asthma. Introduction: The purposes of this project were (a) to examine criteria derived from evidence-based pediatric acute asthma exacerbation assessment tools, asthma scores, and the acute asthma prediction rule validated and used in the emergency department and (b) to adapt these criteria for pediatric primary care. The responses summed to an overall score that ranges from 0 (poor control of asthma) to 27 (complete control of asthma).36. Although internally validated, further external validation of this tool … Programs can use TAARS to conduct a comprehensive or more focused assessment of their referral system. E-mail. For instance, they use different ranges for their scoring systems. The authors reported no evidence of a difference in scores between the complete ACQ (which is here referred to as the ACQ) and ACQ-6a. Sullivan et al68 reported that the costs for uncontrolled asthma, as indicated by the ATAQ score, were more than double those with scores indicating controlled asthma. Similarly, it is not uncommon for patients to overestimate how well their asthma is controlled, and, therefore, they under-report asthma symptoms and fail to recognize the impact that asthma has on their daily life. Nathan et al9 reported high internal consistency of the ACT score with specialists' ratings among subjects with controlled asthma as well as subjects with uncontrolled asthma (0.79 and 0.83, respectively). Lara et al73 assessed the construct validity of the children's version of the LASS score in a sample of Latino parents of children with asthma. The cACT has a strong correlation with the asthma control classification based on GINA guidelines41 as well as with other asthma assessment tools, such as the Pediatric Asthma Quality of Life Questionnaire,42 the Pediatric Asthma Caregiver's Quality of Life Questionnaire,43 and the Child Asthma Short Form.36,44,45 On the contrary, the correlations between the cACT scores and the physiologic tests of asthma, lung function measures and FENO, were not substantial.36,37,39,46, The Cronbach α of .79 indicated good internal consistency of the cACT in the developmental study.36 Also, the cACT had a good test-retest reliability among subjects with the same level of asthma control according to the specialists' rating (r = 0.55).37, Liu et al38 found that 66% of children who were classified as having “very poorly controlled” asthma according to NAEPP EPR-3 guidelines scored 12 or less on the cACT. Research has shown that the factors responsible for asthma symptoms and attacks can vary widely from person to person. The following is a list of tools that can be used to assess asthma control; the list is not exhaustive. Both the National Asthma Education and Prevention Program Expert Panel Report 3 and the 2015 Global Initiative for Asthma guidelines identify achieving and maintaining asthma control as goals of therapy, and they emphasize periodic assessment of asthma control once treatment is established. The commonly used validated tools are the Asthma Control Test (ACT), 7 the Childhood Asthma Control Test C-ACT, 8 and the Asthma Control Questionnaire (ACQ). Olaguibel et al63 argued that Juniper et al62 utilized a composite of GINA/NAEPP EPR-3 guidelines for the data collected in the clinical trial diaries and clinic records to define the level of asthma control. Asthma: Steps in testing and diagnosis Diagnosing asthma generally includes a medical history, physical exam and lung tests. Both tools have been validated for use as self-administered tools in person, at home,40 or by telephone26 and in different languages.18–20 For children, the cACT has more validation data than other tools that target children with asthma.37–39 Also, the populations used in the validation studies vary between tools. Clinicians often overestimate the level of asthma control. The overall AQLQ score is the mean of all 32 responses and the individual domain scores are the means of the items in those domains. The tools included are the Asthma Control Test (ACT), Childhood Asthma Control Test (cACT), Asthma Control Questionnaire (ACQ), Asthma Therapy Assessment Questionnaire (ATAQ), and Lara Asthma Symptom Scale (LASS). Similarly, Chen et al37 reported that mean cACT scores were significantly lower among patients with poor asthma control as compared with those who were well controlled according to specialists' rating. The KSA tools have been designed to provide you with an indication of how much you know about the current state of the art in managing Asthma. The Tool for Assessing Asthma Referral Systems (TAARS) is intended for use by asthma control programs as a guide in helping to understand the how effectively their referral systems are operating within their programs. 92-3091, March 1992, Measuring asthma control: a comparison of three classification systems, Measuring asthma control in group studies: do we need airway calibre and rescue β, Asthma Control Questionnaire in children: validation, measurement properties, interpretation, Validation and psychometric properties of the Asthma Control Questionnaire among children, Development and validation of the Mini Asthma Quality of Life Questionnaire, Quality of life in asthma: I. The Cronbach α was .84 in the children's version73 and .84 in the adult version.74 A Chinese version of the LASS showed high internal consistency as well (Cronbach α = .87).75. A recent study conducted by Vermeulen et al78 reported that only moderate agreement (r = 0.41–0.6) exists between the ACT, ACQ, ATAQ, and 2009 GINA levels of asthma control. Among the tools reviewed, the ACQ has been used in the majority of clinical trials, and the ACT has the most published validation data. Publication no. The tools below were identified from information within the systematic review, from AGREE II-appraised guidelines, by the expert panel, and/or by external stakeholder feedback. It is estimated that 300 million people of all ages and diverse ethnicities suffer from asthma, and about 1 in every 250 is estimated to die from asthma worldwide.1,2, Most of the burden of asthma is attributed to treating patients with uncontrolled asthma.3 Thus, the concept of asthma control is increasingly recognized as a critical aspect of the evaluation and management of the disease. Mini Asthma Quality of Life Questionnaire (mini AQLQ). Bethesda, Maryland 20892. MAAS APT may be a useful tool which combines clinical history and objective measures in predicting future risk of asthma in both clinical and research settings. Does your child’s mattress have a zipped This version was derived from the adult version developed by Vollmer et al.66. It provides a simple assessment for asthma risk at school‐age in young children. An ACQ score has a range from 0 (totally controlled) to 6 (severely uncontrolled).47. However, performing lung function testing or collecting data about the use of short-acting β2 agonist bronchodilators is not always feasible. Intended population: adults with asthma (17 years and older). Whereas the ACQ and ACT are closely aligned with the 2015 GINA and NAEPP EPR-3 guidelines, neither tool assesses the risk of asthma exacerbations, which is an integral part of both guidelines' criteria of asthma control. The LASS is composed of 8 items that assess the frequency of cough, wheezing, shortness of breath, asthma attacks, chest pain, nocturnal symptoms, and overall perception of asthma severity over the previous 4 weeks. Furthermore, the modes and settings in which those tools can be administered vary as well (ie, in-person, at home, over the telephone, in various clinical settings, or over the internet). Nevertheless, the LASS was the only tool reviewed above that evaluated the risk of asthma exacerbations as part of its assessment. Print ISSN: 0020-1324 Online ISSN: 1943-3654. Asthma is a major cause of school absences, which can adversely affect school performance and also result in lost workdays for parents . The questionnaire assesses the level of asthma control during the prior 4 weeks by asking the patient about: (1) self-perception of asthma control; (2) missed work, school, or normal daily activities due to asthma; (3) nighttime waking due to asthma symptoms; and (4) use of short-acting β2 agonist bronchodilators. Similar to most asthma assessment tools, the ACT quan- tifies asthma control as a continuous variable and provides a numeric value to distinguish between controlled and un- controlled asthma. The seventh item is the percent-of-predicted FEV1 before bronchodilator, which is recorded by a clinician. Alpaydin et al11 reported a statistically significant association between ACT and the Asthma Quality of Life Questionnaire (AQLQ).12 Another study13 reported a strong correlation between the ACT and the ACQ.14 In contrast, moderate to low correlations were observed between the ACT score and FEV1, FENO, and specialists' rating of control according to NAEPP EPR-3 guidelines.9,15,16 The substantially low correlations between the ACT scores and physiologic measures of asthma, such as FEV1 values and FENO, support the notion that asthma control cannot be inferred from physiologic measures alone.14,17 Furthermore, the ACT has been validated in many languages18–23 and in different settings, including in asthma specialist consultations,9 in primary care,13 in pharmacies,24 by mail,25 by speech-recognition telephone calls,26 and over the internet.27. 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