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). So You Have Asthma (pdf, 8 MB) NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. You are about to begin the Knowledge Self-Assessment (KSA) for Asthma. Also, when the 4 versions were compared with each other, substantial concordances in both cross-sectional and longitudinal validity were noted. Aim: To measure the adequacy of clinical asthma control. The ACT has 5 questions: 3 related to symptoms, 1 to medication use, and 1 to overall control. For instance, they use different ranges for their scoring systems. Alvarez-Gutiérrez et al15 assessed the test-retest reliability of the ACT on subjects who remain stable at baseline and follow-up visits; they had the same specialist ratings of asthma control on both visits. The review below addressed the validity, reliability, accuracy, and responsiveness of each tool. However, the 4 versions of ACQ had variable agreement when compared with the 2008 GINA and the NAEPP EPR-3 criteria for asthma control. The three questions recommended by the Royal College of Physicians—asking about impact on sleep, daytime symptoms, and impact on activity—are a useful screening tool for uncontrolled asthma.13 Alternative validated scores, such as the Asthma Control Questionnaire and Asthma Control Test, which include reliever use, are also recommended.14 In assessing breathlessness, the NHS 111 … The user can then export it to show it to the doctor. 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. Accuracy is the ability of the tool to distinguish between different patients' categories (ie, different levels of asthma control) against a criterion measure. By Mayo Clinic Staff An asthma diagnosis is based on several factors, including a detailed medical history, a physical exam, your symptoms, and overall health and test results. 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. 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. 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. Thus, although each version is valid in its own right, the lack of consistent agreement between them and the guidelines may make it invalid to use them interchangeably. Asthma Quality of Life Questionnaire (AQLQ). Thus, the ACT has been designated as a core measure for National Institutes of Health (NIH)-initiated clinical research in adults. Intended population: adults with asthma (17 years and older). 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. Weak correlations were observed between the LASS scores and the use of a bronchodilator (r = 0.21), asthma-related emergency department visits (r = 0.18), and hospitalization (r = 0.19).73 The correlation between LASS scores and the lung function tests was weak with percent-of-predicted FEV1 (r = −0.20) and insubstantial with percent-of-predicted peak flow.73 Similarly, LASS scores of the adult version showed strong correlation with AQLQ and weak correlation with FEV1, asthma-related emergency department visits, and hospitalizations. In a prospective study,72 subjects' ATAQ scores at baseline were significantly associated with asthma-specific health-related quality of life at follow up (Mini Asthma Quality of Life Questionnaire: r = −0.49), where a higher number of control problems was associated with an incremental reduction in quality of life. Those children had a lower mean percent-of-predicted FEV1, had more frequent prescriptions to step-up therapy, and were more frequently rated as having severe asthma compared with those who scored 13–19. Several standardized self-administered asthma control assessment tools have been developed to quantify the level of asthma control. In children with asthma, the ACQ demonstrates a good construct validity, as indicated by its strong correlation with the Mini Pediatric Asthma Quality of Life Questionnaire,59 Asthma Control Diary,60 the ACT and cACT, the Pediatric Asthma Quality of Life Questionnaire,42 and the Asthma Symptom Utility Index.53,54,61 Also, the ACQ discriminates between groups of children with asthma based on the presence or absence of clinical events related to asthma control.53,54, The ACQ has shown high reliability in adult subjects who remained clinically stable between consecutive visits to the clinic (an intraclass correlation coefficient of 0.90).14 Also, the mean reliability data provided by the 3 shortened versions of the ACQ were very concordant with the original ACQ at baseline measurement (intraclass correlation coefficient >0.94).58 The children's version of the ACQ demonstrated fair to good internal consistency (Cronbach α of .42–.82) and moderate test-retest reliability (intraclass correlation coefficient = 0.53).54, Juniper et al62 have established the ACQ cutoff points for controlled asthma (≤0.75 points) and not well-controlled asthma (≥1.5 points). The LASS has been developed to measure asthma control in both children73 and adults74 with asthma. As a result, several tools have been developed to quantify the level of asthma control, identify patients at risk, and evaluate the effect of asthma management. This finding limits the ability to use these tools interchangeably. Although assessment of asthma severity is used to guide initiation of therapy, monitoring of asthma control helps determine whether therapy should be maintained or adjusted. Chronic persistent asthma, International consensus report on diagnosis and treatment of asthma, National Heart, Lung, and Blood Institute, National Institutes of Health. 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. Also, the ATAQ score of 3 or greater is the defined cutoff for the NAEPP EPR-3 category of “very poorly controlled” asthma.4. 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. 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. The percentage of patients with asthma on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using a validated asthma control questionnaire (including assessment of short acting beta agonist use), a recording of the number of exacerbations and a written personalised action plan. Registered Nurses' Association of Ontario, Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma. In a 12-month prospective study,67 subjects with ATAQ scores of 3 or 4 (ie, 3 or 4 control problems) were 5 times more likely to be hospitalized, 5.4 times more likely to be seen in an emergency department, and twice as likely to have routine asthma care visits compared with subjects with no control problems. The minimum clinically important difference for the LASS scores was defined for the adult population only.40 Wood et al74 compared the changes in LASS scores with the predetermined clinically important changes in FEV1 (12% change)76 and AQLQ (a change of 0.5 points).77 The authors reported that a change of 7 points in the LASS would represent a clinically important difference. Thank you for your interest in spreading the word on American Association for Respiratory Care. However, a more recent study by Olaguibel et al63 reported poor correlation between these cutoff points and the GINA guidelines' classification of asthma control. Although internally validated, further external validation of this tool … Know your score. The following is a list of tools that can be used to assess asthma control; the list is not exhaustive. https://www.qoltech.co.uk/index.htm. CHAMPS – Child Asthma Risk Assessment Tool (CARAT) Page 3 of 5 http://carat2.asthmarisk.org/ B11. In the developmental study,73 the responsiveness of the LASS was assessed by measuring the changes in the total scores related to the changes in the health status. For instance, in the United States, studies have included mostly white patients. 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. Baseline assessment tool Excel 1.02 MB 12 February 2020 Decision aids Inhalers for asthma (patient decision aid) PDF 448.65 KB 23 May 2019 The authors have disclosed no conflicts of interest. The minimum clinically important difference for ATAQ has not yet been established. The ACT is a patient-centered/completed questionnaire that recalls the patient's experience of 5 items: asthma symptoms (nocturnal and daytime), the use of rescue medications, the effect of asthma on daily functioning, and the patient's perception of asthma control over the previous 4 weeks.9 Each item includes 5 response options corresponding to a 5-point Likert-type rating scale. Yes Asthma is a chronic disease with multiple risk factors and causes. 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. 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. 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. Thus, the ACT has been designated as a core measure for National Institutes of Health (NIH)-initiated clinical research in adults. 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. 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. Overall validity of the ACT has been assessed more than any other asthma control assessment tool. 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. Cross-sectional and longitudinal correlation between ATAQ and health-care utilization has qualified the ATAQ as a supplementary measure for NIH-initiated clinical research in adults.40 Vollmer et al66 reported that only 2% of those with an ATAQ score of 0 had been hospitalized for asthma in the past year, versus 24% of those with an ATAQ score of 4. Knowledge of the psychometric properties of asthma control assessment tools is critical to ensure that the tool selected will measure the desired outcome. However, significant differences were noted between the ACQ and ACQ-5 and between the ACQ and ACQ-6b. 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. Nonetheless, considerable differences between them still exist. Although the ACQ was initially developed for adult patients with asthma, its ability to quantify asthma control level in children was evaluated as well. 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