The LASS, for instance, has been developed for patients of all ages73 The cACT, however, has been developed for patients 4–11 y old.36 Table 1 features the similarities and differences between the reviewed asthma control assessment tools. 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. Sign In to Email Alerts with your Email Address. The most commonly utilized tools are the ACT, cACT, ACQ, and ATAQ. Although internally validated, further external validation of this tool … We do not capture any email address. Thus, the ACT has been designated as a core measure for National Institutes of Health (NIH)-initiated clinical research in adults. On the other hand, another study reported that a cACT score of ≥22 indicated well-controlled asthma, according to the 2008 GINA guidelines.28,29, Changes in the cACT scores correlated well with changes in specialists' ratings of asthma control but correlated poorly with changes in peak expiratory flow rate.37 A score change of 2 points was recently identified as the minimum clinically important difference for cACT.29, The ACQ is another multidimensional, standardized, patient-centered test and is the most widely used asthma control assessment tool in clinical trials.14,40,47 The ACQ was developed specifically to quantify levels of asthma control defined by international guidelines (ie, the British Thoracic Society 1990 guidelines for management of asthma in adults,48 the National Heart, Lung, and Blood Institute 1992 international consensus report on diagnosis and treatment of asthma,49 and the Thoracic Society of Australia and New Zealand 1989 asthma management plan).50 The ACQ involves asking patients to recall their experiences in the previous week and to respond to 6 questions on a 7-point scale about 5 asthma symptoms (nighttime waking, symptoms on waking, activity limitations, shortness of breath, and wheezing) and about the frequency of using short-acting β2 agonists. 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. So You Have Asthma (pdf, 8 MB) These tools are simple and easily completed by patients to facilitate an objective assessment of asthma management. 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. To facilitate an accurate and objective assessment of asthma control, tools that are multidimensional, simple, and relatively short and easy to administer have been developed. 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). 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. 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. This finding limits the ability to use these tools interchangeably. 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 ACT has 5 questions: 3 related to symptoms, 1 to medication use, and 1 to overall control. 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. 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. Despite their availability and widespread promotion, repeated audits … Nonetheless, considerable differences between them still exist. Print ISSN: 0020-1324        Online ISSN: 1943-3654. Thus, the ACT has been designated as a core measure for National Institutes of Health (NIH)-initiated clinical research in adults. Asthma: Steps in testing and diagnosis Diagnosing asthma generally includes a medical history, physical exam and lung tests. Use of a new asthma assessment tool called APGAR leads to improved asthma control and improved patient outcomes in terms of asthma-related emergency, urgent … For instance, they use different ranges for their scoring systems. 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 user can then export it to show it to the doctor. 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. Asthma Assessment Checklist. However, performing lung function testing or collecting data about the use of short-acting β2 agonist bronchodilators is not always feasible. Over the last two decades, British guidelines on the management of asthma have provided evidence-based recommendations for the assessment and management of severe asthma in hospitals. Asthma Control Questionnaire (ACQ) Aim: To measure the adequacy of clinical 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. The assessment tool can also aid in developing materials by identifying topics to be included in a new education piece.In either case,the purpose is to ensure patients are receiving accurate and comprehensive information to help them control their asthma. Bethesda, Maryland 20892. 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. 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. Take the Asthma Control TestTM (ACT) for people 12 yrs and older. Asthma affects 7–10% of children and in any given classroom there will usually be at least one student with asthma (10, 38). 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. The aim of this research was to report the utility of a novel breathing pattern assessment tool (BPAT) to detect BPD in treatment‐refractory asthma. 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. Several standardized self-administered asthma control assessment tools have been developed to quantify the level of asthma control. For instance, in the United States, studies have included mostly white patients. Later, an adult version was developed. The correlations between the ACQ and the shortened versions were high (r = 0.87 with ACQ-5, 0.98 with ACQ-6a, and 0.92 with ACQ-6b).57 A post hoc analysis of 2 large clinical trials showed that all versions of the ACQ were strongly correlated with each other and with the overall score from the AQLQ for both baseline and change scores.57 In another study, Juniper et al58 reported that these 3 shortened versions can be used in large clinical trials without loss of validity or change in interpretation. Also, the ATAQ score of 3 or greater is the defined cutoff for the NAEPP EPR-3 category of “very poorly controlled” asthma.4. 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. 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. Validity is the extent to which a tool measures what it is intended to measure. 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. Finally, responsiveness is the tool's ability to detect important changes over time. 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. Accuracy is the ability of the tool to distinguish between different patients' categories (ie, different levels of asthma control) against a criterion measure. The minimum clinically important difference for a tool is the smallest change in score that can be considered clinically important.35 The minimum clinically important difference enhances the ability of clinicians and researchers to evaluate the effectiveness of interventions. The minimum clinically important difference for ATAQ has not yet been established. 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. The ACT is a patient-centered/com- pleted questionnaire that recalls the patient’s experience of 5 items: asthma symptoms (nocturnal and daytime), the 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. Registered Nurses' Association of Ontario, Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma. Know your score. Furthermore, the ACQ is the only tool included in the above review that comprises lung function as part of the asthma control measure. There are 32 questions in the AQLQ in 4 domains: symptoms, activity limitation, emotional function, and environmental stimuli). However, significant differences were noted between the ACQ and ACQ-5 and between the ACQ and ACQ-6b. Subsequently, responses for each of the 8 items are summed to yield total scores that range from 8 to 40, with higher scores representing more severe asthma symptoms.73 The adult version of the LASS is completed by the patient, and the children's version is completed by the parents of the child with asthma. 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