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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. According to 2008 GINA guidelines,28 which have the same definition and criteria of asthma control as the 2015 GINA guidelines, an ACT score of ≥23 and a score ≤19 indicates well-controlled asthma29 and uncontrolled asthma, respectively.9,13,25,30 A cutoff score of ≤19 was associated with higher risk of adverse asthma outcomes, such as asthma exacerbation17,31 and urgent health-care utilization.17,32 With regard to NAEPP EPR-3 guidelines, a score of ≥20 indicates well-controlled asthma, a score of 16–19 indicates not well-controlled asthma, and a score of ≤15 indicates very poorly controlled asthma.13,33 An ACT score of ≤15 predicted future asthma exacerbations in multiple studies.26,33,34 The variations in the ACT performance against the 2008 GINA and NAEPP EPR-3 guidelines could be attributed to the slight differences between the components of asthma control in the 2 guidelines. The ACQ has 7 questions: 5 related to symptoms, 1 to beta2-agonist use, and 2 related to FEV1 (completed by clinic staff). 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. 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. Instead, Olaguibel et al63 proposed cutoff points of <0.5 for controlled asthma, 0.5–0.99 for partly controlled asthma, and ≥1 for uncontrolled asthma.64 For the children's version of ACQ, a cutoff value of 1.25 for distinguishing between well-controlled and poorly controlled asthma was reported.54. 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). 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. There are 32 questions in the AQLQ in 4 domains: symptoms, activity limitation, emotional function, and environmental stimuli). 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. The nuances of estimation of asthma control include understanding concepts of current impairment and future risk and incorporating their measurement into clinical practice. 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. Asthma is a chronic disease with multiple risk factors and causes. Asthma affects 7–10% of children and in any given classroom there will usually be at least one student with asthma (10, 38). Asthma: Steps in testing and diagnosis Diagnosing asthma generally includes a medical history, physical exam and lung tests. 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 AC… 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. 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 Bethesda, Maryland 20892. 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. 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). 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. Asthma Knowledge Self-Assessment. This version was derived from the adult version developed by Vollmer et al.66. 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. 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 … 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 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 LASS has been developed to measure asthma control in both children73 and adults74 with asthma. The ACT has 5 questions: 3 related to symptoms, 1 to medication use, and 1 to overall control. 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. However, performing lung function testing or collecting data about the use of short-acting β2 agonist bronchodilators is not always feasible. 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. 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. Does your child’s mattress have a zipped The total scores were lower after resolution of asthma exacerbation compared with the scores during the exacerbation. The following is a list of tools that can be used to assess asthma control; the list is not exhaustive. Later, an adult version was developed. Furthermore, the ACQ is the only tool included in the above review that comprises lung function as part of the asthma control measure. Initially, the LASS was developed as an English and Spanish symptom scale to measure asthma control in children of non-English-speaking populations. 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. The ACQ has 7 questions: 5 related to symptoms, 1 to beta 2-agonist use, and 2 related to FEV 1 (completed by clinic staff). 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. 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. The user can then export it to show it to the doctor. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Welcome to the Child Asthma Risk Assessment Tool, or CARAT, an app for generating a personalized asthma risk profile for children with asthma. However, in the developmental study of the children and adolescent ATAQ, the Cronbach α of .75 indicated good internal consistency of the ATAQ.71, An ATAQ score of 1 or greater was used as an established cutoff value for uncontrolled versus controlled asthma. This finding limits the ability to use these tools interchangeably. 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). Yes Knowledge of the psychometric properties of asthma control assessment tools is critical to ensure that the tool selected will measure the desired outcome. Mini Asthma Quality of Life Questionnaire (mini AQLQ). 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. Despite their availability and widespread promotion, repeated audits … 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. Also, a review by Halbert et al10 highlighted the discrepancy between the content of most of the tools and the national and international guidelines. 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. Programs can use TAARS to conduct a comprehensive or more focused assessment of their referral system. 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. Print ISSN: 0020-1324        Online ISSN: 1943-3654. The targeted patient age is another difference among tools. 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. Know your score. 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. An ACQ score has a range from 0 (totally controlled) to 6 (severely uncontrolled).47. Publication no. 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. The review below addressed the validity, reliability, accuracy, and responsiveness of each tool. 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). Sign In to Email Alerts with your Email Address. Nevertheless, the LASS was the only tool reviewed above that evaluated the risk of asthma exacerbations as part of its assessment. 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 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. 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 seventh item is the percent-of-predicted FEV1 before bronchodilator, which is recorded by a clinician. Asthma Quality of Life Questionnaire (AQLQ). 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). 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. Asthma is a major cause of school absences, which can adversely affect school performance and also result in lost workdays for parents . 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 most commonly utilized tools are the ACT, cACT, ACQ, and ATAQ. The ACQ score is the mean of the 7 items, which gives all items equal weight. The minimum clinically important difference for ATAQ has not yet been established. Recent studies found that the ACQ is valid for use in children 6–17 y old. 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. 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. Research has shown that the factors responsible for asthma symptoms and attacks can vary widely from person to person. 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. Also, a higher ATAQ score (more control problems) was associated with lower quality of life in subjects with asthma, indicated by generic and disease-specific quality of life measures, such as the SF-36, the standardized version of the Asthma Quality of Life Questionnaire,12 and the Mini Asthma Quality of Life Questionnaire.55,68 Furthermore, a strong correlation and similar performance were reported between the ATAQ and the ACT at home and in clinical settings (r = −0.73).25,69,70, The reliability of the ATAQ has not been evaluated for the adult version. For instance, in the United States, studies have included mostly white patients. In another study, Meltzer et al65 reported that with each point increase in the ACQ score, there is a 50% higher risk of exacerbations. The authors have disclosed no conflicts of interest. However, the 4 versions of ACQ had variable agreement when compared with the 2008 GINA and the NAEPP EPR-3 criteria for asthma control. Thus, the ACT has been designated as a core measure for National Institutes of Health (NIH)-initiated clinical research in adults. 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. E-mail. 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. Aim: To measure the adequacy of clinical asthma control. 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. Clinicians often overestimate the level of asthma control. CHAMPS – Child Asthma Risk Assessment Tool (CARAT) Page 3 of 5 http://carat2.asthmarisk.org/ B11. 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. 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. However, a more recent study by Olaguibel et al63 reported poor correlation between these cutoff points and the GINA guidelines' classification of asthma control. Take the Asthma Control TestTM (ACT) for people 12 yrs and older. Thus, the ACT has been designated as a core measure for National Institutes of Health (NIH)-initiated clinical research in adults. You are about to begin the Knowledge Self-Assessment (KSA) for Asthma. The authors reported a test-retest reliability of 0.77. The authors reported moderate to strong association between both English and Spanish LASS scores and other measures of functional status, such as asthma-related school days lost (r = 0.53) and asthma-related activity days lost (r = 0.50). 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. 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. 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). 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. 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. There are 15 questions in 4 domains: symptoms, activity limitations, emotional function, and environmental stimuli. 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