Asthma Questionnaires - Donnell (9 09)

8/8/2019 Asthma Questionnaires - Donnell (9 09)

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Measuring Asthma ControlMeasuring Asthma Controlwith Patientwith Patient--CompletedCompleted

QuestionnairesQuestionnairesAaron Donnell, MDAaron Donnell, MD

Chicago Family Asthma & Allergy, SCChicago Family Asthma & Allergy, SC

ChildrenChildrens Community Physicianss Community PhysiciansAssociation MemberAssociation Member


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Measuring Asthma Control withPatient Questionnaires

Disclosure of Conflict of Interest Information

I have the following relationship that exists related to this

presentation:

Speaker for GlaxoSmithKline, who supported development of

the Asthma Control Test (ACT) and Asthma ControlQuestionnaire (ACQ). The content of todays talk does not

include pharmaceutical product information from those

presentations.

Disclosure information stated above is current as of 09/09/09


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Measuring Asthma Control withMeasuring Asthma Control with

Patient QuestionnairesPatient Questionnaires

ObjectivesObjectives

Discuss the assessment and measurementDiscuss the assessment and measurementof asthmaof asthma impairmentimpairment and itsand its

application to asthmaapplication to asthma controlcontrol.. Discuss patientDiscuss patient--completed questionnairescompleted questionnaires

(ACQ, ATAQ, and ACT) as tools to assess(ACQ, ATAQ, and ACT) as tools to assess

impairment in schoolimpairment in school--aged children andaged children andadults.adults.


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NHLBI NAEPP EPRNHLBI NAEPP EPR--3 20073 2007Guidelines for the Diagnosis andGuidelines for the Diagnosis and

Management of AsthmaManagement of Asthma

Control: the degree to which theControl: the degree to which themanifestations of asthma (symptoms,manifestations of asthma (symptoms,functionalfunctional impairmentsimpairments, and, and risksrisks ofof

untoward events) areuntoward events) are minimizedminimized and theand thegoals of therapy are met.goals of therapy are met.


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EPREPR--3 2007 Guidelines3 2007 Guidelines AsthmaAsthma severity:severity:

Typically assessed at the time of disease presentation.Typically assessed at the time of disease presentation. Details a chronic status that represents the individualDetails a chronic status that represents the individual

patientpatients potential impairment and risk.s potential impairment and risk.

AsthmaAsthma controlcontrol :: More volatile status that can be consistentlyMore volatile status that can be consistently

inconsistent for some asthmatics.inconsistent for some asthmatics.

Represents a point in time where impairment and riskRepresents a point in time where impairment and riskcan be evaluated and measured.can be evaluated and measured.


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EPREPR--3 2007 Guidelines3 2007 GuidelinesControllingControlling impairmentimpairment::

Prevent chronic and troublesomePrevent chronic and troublesome symptomssymptoms (e.g.,(e.g.,coughing or breathlessness in the daytime, in the night,coughing or breathlessness in the daytime, in the night,or after exertion).or after exertion).

Require infrequent use (Require infrequent use (

2 days a week) of inhaled2 days a week) of inhaledshort acting betashort acting beta--agonistsagonists for quick relief of symptoms.for quick relief of symptoms.

Maintain (near)Maintain (near) normalnormal pulmonary functionpulmonary function..

Maintain normalMaintain normal activityactivity levels (including exercise, otherlevels (including exercise, other

physical activity and attendance at work or school).physical activity and attendance at work or school).

Meet patientsMeet patients and familiesand families expectationsexpectations of andof andsatisfaction with asthma care.satisfaction with asthma care.


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EPREPR--3 2007 Guidelines3 2007 Guidelines


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PatientPatient--Completed QuestionnairesCompleted Questionnaires

ATAQATAQ

Answer The Asthma Questions!Answer The Asthma Questions!

ACQACQ

Another Clinic QuandaryAnother Clinic Quandary

ACTACT

Application for Cat TakeApplication for Cat Take--awayaway


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PatientPatient--Completed QuestionnairesCompleted Questionnaires

ATAQATAQ

Asthma Therapy AssessmentAsthma Therapy AssessmentQuestionnaireQuestionnaire

ACQACQ

Asthma Control QuestionnaireAsthma Control Questionnaire

ACTACTAsthma Control TestAsthma Control Test


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Asthma Control QuestionnaireAsthma Control Questionnaire

(ACQ)(ACQ)


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Asthma Control Questionnaire (ACQ)Asthma Control Questionnaire (ACQ)

Goals of development:Goals of development:1.1. Include symptoms that asthma clinicians consider to be mostInclude symptoms that asthma clinicians consider to be most

important for assessing adequacy of asthma control.important for assessing adequacy of asthma control.2.2. Include a measure of:Include a measure of:

a)a) ShortShort--acting beta2acting beta2--agonist use andagonist use and

b)b) Airway caliber.Airway caliber.

3.3. Be applicable to all adults with asthma.Be applicable to all adults with asthma.

4.4. Be reliable (reproducible when the clinical state is stable andBe reliable (reproducible when the clinical state is stable and able toable todiscriminate between patients with different levels of asthmadiscriminate between patients with different levels of asthmacontrol).control).

5.5. Be sensitive to small but clinically important changes in asthmBe sensitive to small but clinically important changes in asthmaacontrol.control.

6.6. Be valid (actually measure asthma control).Be valid (actually measure asthma control).

7.7. Be short and easy to complete.Be short and easy to complete.

Juniper EF, et al. 1999b.


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One hundred asthma specialists asked toOne hundred asthma specialists asked to

rate symptoms in order of importance forrate symptoms in order of importance for

evaluating asthma control.evaluating asthma control.


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Asthma Control Questionnaire (ACQ)Asthma Control Questionnaire (ACQ) Top five scoring elements of control from asthma specialistsTop five scoring elements of control from asthma specialists

answers included in ACQ:answers included in ACQ:

Awoken at night by symptomsAwoken at night by symptoms Limitation of normal daily activitiesLimitation of normal daily activities

Waking in the morning with symptomsWaking in the morning with symptoms

DyspnoeaDyspnoea

WheezeWheeze

Included a measure of shortIncluded a measure of short--acting beta2acting beta2--agonist use andagonist use andairway caliber (most preferred preairway caliber (most preferred pre--bronchodilator FEV1 %bronchodilator FEV1 %predicted).predicted).

Patients recall their experiences during the previousPatients recall their experiences during the previous 7 days7 daysand respond to each question using aand respond to each question using a 77--pointpoint scale.scale.



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THE Question aboutTHE Question aboutQuestionnaires:Questionnaires:

But how do we know if itBut how do we know if itss

any good?any good?


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Brief Interlude:Brief Interlude:

Asthma Quality of Life Questionnaire (AQLQ)Asthma Quality of Life Questionnaire (AQLQ)

Gold standardGold standard for asthmafor asthma--specific disease quality of lifespecific disease quality of lifemeasurement =measurement =great way to validate new questionnairesgreat way to validate new questionnaires

The AQLQ(S) is a 32The AQLQ(S) is a 32--item, diseaseitem, disease--specific questionnaire that usesspecific questionnaire that usesstandardized activities to measure limitations.standardized activities to measure limitations.

Strong measurement properties and validity for measurements ofStrong measurement properties and validity for measurements offunctional impairment in adults with asthma.functional impairment in adults with asthma.

Patients score their experiences during the last 2 weeks on a 7Patients score their experiences during the last 2 weeks on a 7--pointpointscale (1: severe impairment to 7: no impairment).scale (1: severe impairment to 7: no impairment).

Contains 12 items onContains 12 items on symptomssymptoms, 11 items on, 11 items on activity limitationsactivity limitations, 5, 5items onitems on emotional functionsemotional functions, and 4 items concerning, and 4 items concerning environmentalenvironmental

stimulistimuli.. A score change of 0.5 points is considered to be clinically impA score change of 0.5 points is considered to be clinically importantortant

and is termed theand is termed the minimal important difference.minimal important difference.

Juniper EF, et al. 1994.Juniper EF, et al. 1999.


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Back to the ACQBack to the ACQ

Juniper EF, et al. 1999b.Juniper EF, et al. 2006.

Validated against the Asthma Quality of LifeValidated against the Asthma Quality of Life

Questionnaire (AQLQ) and Medical Outcomes SurveyQuestionnaire (AQLQ) and Medical Outcomes SurveyShort FormShort Form--36 (SF36 (SF--36).36).

Final score: theFinal score: the meanmean of the scores for the 7 items.of the scores for the 7 items.

Value less than or equal toValue less than or equal to 0.750.75:: WellWell--ControlledControlled, using, using

the Gaining Optimal Asthma Control (GOAL)the Gaining Optimal Asthma Control (GOAL)classification.classification.

Value of greater than or equal toValue of greater than or equal to 1.501.50:: Not WellNot Well--

ControlledControlled..


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Example adult patient:Example adult patient:

Uses albuterol on average 2 puffs daily.Uses albuterol on average 2 puffs daily. Uses albuterol for very mild wheezing or shortness ofUses albuterol for very mild wheezing or shortness of

breath on early waking or with exercise.breath on early waking or with exercise.

Once a week middle of the night chest tightness.Once a week middle of the night chest tightness.

FEV1% 90% predicted in your office.FEV1% 90% predicted in your office.

Result:Result: 11 (two puffs albuterol) +(two puffs albuterol) + 11 ((very mildvery mild wakingwakingsymptoms) +symptoms) + 11 (limited activity(limited activity very slightlyvery slightly) +) + 22

(wheezing(wheezing little of the timelittle of the time) +) + 22 (shortness of breath(shortness of breath aalittlelittle) +) + 22 (nocturnal waking(nocturnal waking few minutesfew minutes/week) +/week) + 11(FEV1 90(FEV1 90--95%) =95%) = 1010, 10/7 =, 10/7 =

1.421.42 ((indeterminateindeterminate))


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Ehrs, P-O, et al, 2006.

AA shortened ACQshortened ACQ was developed in 2006 that left outwas developed in 2006 that left out

the SABA and FEV1% data.the SABA and FEV1% data. Also correlated well with the AQLQ(S).Also correlated well with the AQLQ(S).

More efficient for primary care settings by removingMore efficient for primary care settings by removingneed to perform FEV1%.need to perform FEV1%.

Modern LABA use confounded FEV1% predictability.Modern LABA use confounded FEV1% predictability.

Removed concern that difficulty with spirometryRemoved concern that difficulty with spirometrytechnique could alter control assessment.technique could alter control assessment.

5 questions reduces dilution of each independent5 questions reduces dilution of each independentvariable in determining control.variable in determining control.


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Uses albuterol on average 2 puffs daily.Uses albuterol on average 2 puffs daily. Uses albuterol for very mild wheezing or shortness ofUses albuterol for very mild wheezing or shortness of

breath on early waking or with exercise.breath on early waking or with exercise.



Result:Result: 11 ((very mildvery mild waking symptoms) +waking symptoms) + 11 (limited(limitedactivityactivity very slightlyvery slightly) +) + 22 (wheezing(wheezing little of thelittle of the

timetime) +) + 22 (shortness of breath(shortness of breath a littlea little) +) + 22 (nocturnal(nocturnalwakingwaking few minutesfew minutes/week) =/week) = 88, 8/5 =, 8/5 =

1.61.6 ((Not Well ControlledNot Well Controlled))


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Criticisms:Criticisms: Most patientsMost patients scores are less than or equal to 2.5, with scores ofscores are less than or equal to 2.5, with scores of

greater than or equal to 4 only occurring with severe exacerbatigreater than or equal to 4 only occurring with severe exacerbations.ons. The 7The 7--point response scales may be more complex and timepoint response scales may be more complex and time--

consuming than is necessary.consuming than is necessary.

ACQ values ofACQ values of0.760.761.4 are indeterminate1.4 are indeterminate regarding wellregarding well--controlledcontrolled

asthma.asthma.

Good and bad: although the ACQ includes preGood and bad: although the ACQ includes pre--bronchodilatorbronchodilatorFEV1%, an element of impairment measurement and a goodFEV1%, an element of impairment measurement and a goodpredictor for future exacerbations, change in this component maypredictor for future exacerbations, change in this component maybebeoutweighed by the remaining six components.outweighed by the remaining six components.

Developed using only 50 asthmatic individuals in a homogeneousDeveloped using only 50 asthmatic individuals in a homogeneousCaucasian population, variations due to ethnic diversity orCaucasian population, variations due to ethnic diversity orpopulation size may affect applicability.population size may affect applicability.


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Asthma Therapy AssessmentAsthma Therapy Assessment

QuestionnaireQuestionnaire(ATAQ)(ATAQ)


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Asthma Therapy Assessment QuestionnaireAsthma Therapy Assessment Questionnaire

(ATAQ)(ATAQ) 44--question, 4question, 4--pointpointsurvey covering the lastsurvey covering the last 4 weeks4 weeks::

Work, school, or daily activities.Work, school, or daily activities.

NightNight--time waking.time waking. Patient selfPatient self--assessment of control.assessment of control.

Short acting beta2Short acting beta2--agonist use.agonist use.

Each elementEach element dichotomizeddichotomized: one point is bad, zero is good.: one point is bad, zero is good.

00 = well= well--controlled.controlled. 11--22 = not well= not well--controlled.controlled.

33--44 = very poorly controlled.= very poorly controlled.

Originally analyzed in Kaiser Permanente population in Portland,Originally analyzed in Kaiser Permanente population in Portland,

Oregon, age 18 and older, with 5,181 participants who reportedOregon, age 18 and older, with 5,181 participants who reporteddoctordoctor--diagnosed asthma and had taken asthma medications withindiagnosed asthma and had taken asthma medications withinthe past 12 months.the past 12 months.

Vollmer WM, et al, 1999.


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Asthma Therapy Assessment Questionnaire (ATAQ)Asthma Therapy Assessment Questionnaire (ATAQ)



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(ATAQ)(ATAQ) Validated for good correlation with generic and diseaseValidated for good correlation with generic and disease--specificspecific

indices of quality of life: Shortindices of quality of life: Short--Form Health Survey [SFForm Health Survey [SF--36] and36] andStandardized AQLQ.Standardized AQLQ.

Significant association between number of control problems in thSignificant association between number of control problems in theepast 4 weekspast 4 weeks andand 3 different measures of self3 different measures of self--reportedreported acute healthacute healthcare utilizationcare utilization for asthma in the past year:for asthma in the past year: doctor visits, emergencydoctor visits, emergencydepartment care, and hospitalizationsdepartment care, and hospitalizations..

The proportion of individuals reporting each measure increasedThe proportion of individuals reporting each measure increasedsignificantly as the number ofsignificantly as the number ofcontrol problemscontrol problems increased.increased.

The proportion reportingThe proportion reporting hospitalization for asthma in the pasthospitalization for asthma in the pastyearyear increased fromincreased from 2% to 24%2% to 24% comparing a score of 0 to 4,comparing a score of 0 to 4,

respectively.respectively. The proportion reportingThe proportion reporting two or more outpatient visits for acutetwo or more outpatient visits for acute

attacksattacks increased fromincreased from 19% to 72%19% to 72% comparing a score of 0 to 4,comparing a score of 0 to 4,respectively.respectively.



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(ATAQ)(ATAQ)


Uses albuterol on average 2 puffs daily.Uses albuterol on average 2 puffs daily. Uses albuterol for very mild wheezing or shortness of breath onUses albuterol for very mild wheezing or shortness of breath on

early waking or with exercise.early waking or with exercise.


FEV1% 90% predicted in your office.FEV1% 90% predicted in your office.1.1. In the past 4 weeks did you miss any work, school, or normal daiIn the past 4 weeks did you miss any work, school, or normal dailyly

activities because of your asthma? (1 point for YES)activities because of your asthma? (1 point for YES)

2.2. In the past 4 weeks, did you wake up at night because of your asIn the past 4 weeks, did you wake up at night because of your asthma? (1thma? (1point for YES)point for YES)

3.3. Do you believe your asthma was well controlled in the past 4 weeDo you believe your asthma was well controlled in the past 4 weeks? (1ks? (1point for NO)point for NO)

4.4. Do you use an inhaler for quick relief from asthma symptoms? IfDo you use an inhaler for quick relief from asthma symptoms? Ifyes, whatyes, whatis the highest number of puffs in 1 day you took of this inhaleris the highest number of puffs in 1 day you took of this inhaler? (1 point for? (1 point for

more than 12)more than 12)


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(ATAQ)(ATAQ)


Uses albuterol on average 2 puffs daily.Uses albuterol on average 2 puffs daily. Uses albuterol for very mild wheezing or shortness of breath onUses albuterol for very mild wheezing or shortness of breath on

early waking or with exercise.early waking or with exercise.



Result:Result: 11 (Missed activity) +(Missed activity) + 11 (nocturnal waking) +(nocturnal waking) + 11(doesn(doesnt feel wellt feel well--controlled) +controlled) + 00 (less than 12 puffs/day(less than 12 puffs/day

albuterol) =albuterol) = 3333 isis Very Poorly ControlledVery Poorly Controlled ((33--44))


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(ATAQ)(ATAQ)Criticisms:Criticisms:

Good:Good:

Very simple to use.Very simple to use.

Good validity data.Good validity data.

Negative:Negative:

Smaller scale makes degrees of change difficult toSmaller scale makes degrees of change difficult toassess.assess.

Less reports of its use in clinical practice and clinicalLess reports of its use in clinical practice and clinical

trials.trials. An ATAQ developed for children and adolescents,An ATAQ developed for children and adolescents,

but 20 questions difficult in office setting.but 20 questions difficult in office setting.

Skinner EA, et al. 2004.


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Asthma Control TestAsthma Control Test

(ACT)(ACT)


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Asthma Control Test (ACT)Asthma Control Test (ACT)

In developing the Asthma Control TestIn developing the Asthma Control Test(ACT), the investigators sought to:(ACT), the investigators sought to:

Produce a questionnaire that reflected theProduce a questionnaire that reflected themultidimensional nature of asthma control.multidimensional nature of asthma control.

Demonstrate its performance against criterionDemonstrate its performance against criterionmeasures of asthma control.measures of asthma control.

Nathan RA, et al. 2004


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Asthma Control Test (ACT)Asthma Control Test (ACT) Four primary care clinicians and seven asthma specialists specifFour primary care clinicians and seven asthma specialists specifiedied

the essential components of asthma control defined a criterionthe essential components of asthma control defined a criterion

measure of asthma control.measure of asthma control. Each survey item asked the respondent to consider the lastEach survey item asked the respondent to consider the last 4 weeks4 weeks

(n=407, ages 12(n=407, ages 12--94).94).

The asthma specialist interviewed and examined the patient andThe asthma specialist interviewed and examined the patient and

rated the level of asthma control on a NHLBI guidelinerated the level of asthma control on a NHLBI guideline--basedbased55--point scalepoint scale :: Not controlled at allNot controlled at all

Poorly controlledPoorly controlled

Somewhat controlledSomewhat controlled Well controlledWell controlled

Completely controlledCompletely controlled



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Asthma Control Test (ACT)Asthma Control Test (ACT) Validation methods categorized patients into groupsValidation methods categorized patients into groups

known to differ in asthma control derived from 3known to differ in asthma control derived from 3criterion measures.criterion measures.

SpecialistSpecialists rating of controls rating of control

FEV1% predictedFEV1% predicted

Whether the specialist changed the patientWhether the specialist changed the patientsstherapy as a result of the visit: stepped downtherapy as a result of the visit: stepped downtherapy, no change in therapy, and stepped uptherapy, no change in therapy, and stepped up

therapy.therapy.



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Asthma Control Test (ACT)Asthma Control Test (ACT) Forward stepwise logistic regression analysesForward stepwise logistic regression analyses

showed 5 items correlating with specialistshowed 5 items correlating with specialist

assessment:assessment: Shortness of breathShortness of breath

PatientPatients rating of asthma controls rating of asthma control

Use of rescue medicationUse of rescue medication Role limitations due to asthmaRole limitations due to asthma

Nocturnal asthma symptomsNocturnal asthma symptoms

Similar reliability in scoring methods using 5 pointSimilar reliability in scoring methods using 5 pointscale for each item or dichotomous 0scale for each item or dichotomous 0--1 scale for each1 scale for eachitemitem



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Asthma Control TestAsthma Control Test

Asthma Control Test is a trademark of QualityMetric Incorporated. See www.asthmacontroltest.com.


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Asthma Control Test (ACT)Asthma Control Test (ACT) ValueValue19 predicting uncontrolled asthma:19 predicting uncontrolled asthma:

Sensitivity 69.2%Sensitivity 69.2%

Specificity 76.2%Specificity 76.2% Positive Predictive Value 56.1%Positive Predictive Value 56.1%

Negative Predictive Value 84.9%Negative Predictive Value 84.9%

Percent correctly classified per specialist 74.1%Percent correctly classified per specialist 74.1%

Highest area under the ROC curveHighest area under the ROC curve

Mean ACT scores differed significantly across definedMean ACT scores differed significantly across definedpatient categories:patient categories:

SpecialistSpecialists rating of controls rating of control Percent predicted FEV1 levelsPercent predicted FEV1 levels

Therapy was stepped up vs. stepped down or not changedTherapy was stepped up vs. stepped down or not changed



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Asthma Control Test (ACT)Asthma Control Test (ACT) Stronger correlation between the ACT scores and theStronger correlation between the ACT scores and the

specialistspecialists rating of control than between FEV1 and thes rating of control than between FEV1 and the

specialistspecialists rating of control (confirming that asthmas rating of control (confirming that asthmacontrol cannot be inferred from the clinical measure ofcontrol cannot be inferred from the clinical measure ofairway function alone).airway function alone).

Cutpoint forCutpoint for wellwell--controlled asthma > 19controlled asthma > 19 andand poorlypoorly

controlled asthma < 16controlled asthma < 16..

A change in ACT score of 1.88 corresponds to a changeA change in ACT score of 1.88 corresponds to a changeof one level in physician rating of asthma control.of one level in physician rating of asthma control.

In a comparative study, ACT and ACQ showed similarIn a comparative study, ACT and ACQ showed similarreproducibility, discriminate validity, and sensitivity orreproducibility, discriminate validity, and sensitivity orspecificity for detecting poorly controlled asthma.specificity for detecting poorly controlled asthma.

Nathan RA, et al. 2004Schatz M, et al. 2006


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Asthma Control Test (ACT)Asthma Control Test (ACT)Example adult patient:Example adult patient: Uses albuterol on average 2 puffs daily.Uses albuterol on average 2 puffs daily.

Uses albuterol for very mild wheezing or shortness of breath onUses albuterol for very mild wheezing or shortness of breath onearly waking or with exercise.early waking or with exercise.



Result:Result: 44 ((little of the timelittle of the time kept from getting much donekept from getting much donework, school, home) +work, school, home) + 22 (shortness of breath(shortness of breath once aonce a

dayday) +) + 22 ((two or three nights a weektwo or three nights a week awake or earlyawake or earlymorning) +morning) + 22 (rescue(rescue one or two times per dayone or two times per day) +) + 33(self(self--ratingrating somewhat controlledsomewhat controlled))

1313 isis uncontrolleduncontrolled (95% specificity)(95% specificity)

Childh d A h C l TChildh d A th C t l T t


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Childhood Asthma Control TestChildhood Asthma Control Test

(C(C--ACT)ACT) Kids may speak when spoken toKids may speak when spoken to: studies how child: studies how child--

reported asthma symptom reports correlate better withreported asthma symptom reports correlate better withFEV1 and qualityFEV1 and quality--ofof--life measures than parent reports.life measures than parent reports.

For CFor C--ACT development, children 4ACT development, children 4--11 years old were11 years old wereasked about the present, because children 4asked about the present, because children 4--6 years of6 years of

age had difficulty recalling beyond 1 day.age had difficulty recalling beyond 1 day. Younger children tended to use more extreme responsesYounger children tended to use more extreme responses

and had difficulties understanding a neutral state, so a 4and had difficulties understanding a neutral state, so a 4--

point scale was chosen.point scale was chosen.

Guyatt GH, et al. 1997.Lara M, et al. 1998.Liu AH, et al. 2007.

Childh d A th C t l T tChildh d A th C t l T t


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(C(C--ACT)ACT) Similar validation techniques to ACTSimilar validation techniques to ACT

Cutoff for uncontrolled asthma found best at < 20.Cutoff for uncontrolled asthma found best at < 20. Significant correlation to criteria defined:Significant correlation to criteria defined:

Somewhat or poorly controlledSomewhat or poorly controlled

Requiring step up in therapyRequiring step up in therapy


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Asthma Control Test (ACT)Asthma Control Test (ACT) Validated for administrationValidated for administration at homeat home::

Confirmed optimal cutoff for wellConfirmed optimal cutoff for well--controlled > 19 andcontrolled > 19 and

poorly controlled asthma as 16poorly controlled asthma as 16 Significantly correlated with findings on the ATAQ andSignificantly correlated with findings on the ATAQ and

MiniMini--AQLQAQLQ

Validated for administration by interactiveValidated for administration by interactive telephone callstelephone calls

using speech recognition technologyusing speech recognition technology.. Score < 16 significantly related to emergency hospital careScore < 16 significantly related to emergency hospital care

and oral corticosteroid and betaand oral corticosteroid and beta--agonist dispensingagonist dispensing

Concordance between CConcordance between C--ACT < 19 andACT < 19 and FeNO > 20 ppbFeNO > 20 ppb.. Studies confirm its use as aStudies confirm its use as a complement, not a replacementcomplement, not a replacement,,

to such objective measures.to such objective measures.Schatz M, et al. 2007.Schatz M, et al. 2007.Piacentini G, et al. 2009

R lR l ld E l i f A hld E l ti f A th


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RealReal--world Evaluation of Asthmaworld Evaluation of Asthma

Control and Treatment (REACT)Control and Treatment (REACT)

New tool to compute the risk of having uncontrolledNew tool to compute the risk of having uncontrolled

asthma based on patient attitudes toward medicalasthma based on patient attitudes toward medicalprofessionals and asthma treatment.professionals and asthma treatment. Believed that their physician recognized lifestyle compromisesBelieved that their physician recognized lifestyle compromises

due to asthma.due to asthma.

Not satisfied with their treatment regimen.Not satisfied with their treatment regimen. Took asthma medication more frequently than prescribed.Took asthma medication more frequently than prescribed.

May improve communication between asthmaticMay improve communication between asthmaticpatients and their physicians by identifying patientpatients and their physicians by identifying patientconcerns regarding their treatment and quality of life.concerns regarding their treatment and quality of life.

Jones C, et al. 2009.


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Summary: Positive Aspects for QSummary: Positive Aspects for Qss Encourages guidelineEncourages guideline--based asthmabased asthma

evaluation respect to identifying control.evaluation respect to identifying control. Encourage patient and parent disease selfEncourage patient and parent disease self--

awareness.awareness.

RapidRapid assessments are helpful measuringassessments are helpful measuringtools.tools.

Validation allows standardizedValidation allows standardizedcomparisons between patients andcomparisons between patients andindividual patient visits.individual patient visits.


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Summary: Negative Aspect for QSummary: Negative Aspect for Qss According to the NHLBI Guidelines:According to the NHLBI Guidelines:

Some patients, however, appear to perceive theSome patients, however, appear to perceive theseverity of airflow obstruction poorly.severity of airflow obstruction poorly. May unconsciously accommodate to their symptoms.May unconsciously accommodate to their symptoms.

May mistakenly attribute symptoms to other causes:May mistakenly attribute symptoms to other causes:

AgingAging ObesityObesity

Lack of fitnessLack of fitness

Another measure may identify that the degree of airflow obstructAnother measure may identify that the degree of airflow obstruction ision ispoorly recognized or perceived by the patient:poorly recognized or perceived by the patient:

SpirometrySpirometry

A trial of therapy with improved quality of life (A trial of therapy with improved quality of life (I did not realize howI did not realize howmuch better I could feel until my asthma was treated.much better I could feel until my asthma was treated.))

1. Bijl-Hofland et al. 2000.2. Kikuchi et al. 1994.


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Questions for Me?Questions for Me?


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Asthma Questionnaires - Donnell (9 09)