Asthma Therapy Assessment Questionnaire Research Articles

Pediatric Asthma Therapy Assessment Questionnaire for the Brazilian population: Cross-cultural adaptation and measurement properties.

To cross-culturally adapt the Pediatric Asthma Therapy Assessment Questionnaire (ATAQ) into Brazilian Portuguese and analyze its measurement properties. This exploratory methodological study included eight experts and 30 caregivers in the translation and cross-cultural adaptation steps. Thereafter, 118 caregivers of pediatric patients with asthma aged between 5 and 17 years were involved in the analysis of measurement properties. We analyzed the content, structural (exploratory and confirmatory factorial), construct (convergent and discriminant), and known-groups validities; floor and ceiling effects; and determined the cut-off point (receiver operator characteristic curve) to identify pediatric patients with uncontrolled asthma. Intraclass correlation coefficient (ICC) analyzed test-retest reliability with 54 caregivers, whereas Cronbach's α and composite reliability verified the internal consistency of the items. The committee of experts and caregivers found the instructions and response options relevant, understandable, and clear (K > 0.75). During the cross-cultural adaptation, three items (2, 4, and 12) were slightly modified by including terms to facilitate understanding. A two-factor structure (asthma control and patient-provider communication) was identified. Internal consistency (α > .67; composite reliability > 0.73) and test-retest reliability (ICC > 0.80) were acceptable. For construct and know-groups validities, 85.71% of the hypothesis were confirmed. A cut-off point of >3 for the control domain was considered adequate to identify pediatric patients with uncontrolled asthma (sensitivity: 86.21%; specificity: 80.90%). The Pediatric ATAQ was adequately adapted for Brazilian pediatric patients with asthma and produced valid and reliable measures for assessing asthma control. Therefore, it may be considered an adequate instrument for monitoring asthma control in the Brazilian pediatric population.

Spatial analysis of tobacco outlet density on secondhand smoke exposure and asthma health among children in Baltimore City

RationaleTobacco outlets are concentrated in low-income neighbourhoods; higher tobacco outlet density is associated with increased smoking prevalence. Secondhand smoke (SHS) exposure has significant detrimental effects on childhood asthma. We hypothesised...

Magnesium levels in stable children with asthma: It’s relationship with asthma control

Background: Asthma prevalence is rising worldwide. Amongst the various factors influencing asthma control, the magnesium level of the affected individuals seems to make a major contribution to achieving asthma control through i ts anti - inflammatory and bronchodilation effects.This study therefore was aimed at determining the magnesium level of stable asthmatic children and its relationship, if any, with their levels of asthma control.Methods: A cross-sectional study where the serum magnesium levels of 30 stable asthmatic children attending Asthma clinic and those of 30 children without asthma attending Children Out-patient clinic (CHOP) both at the University of Nigeria Teaching Hospital (UNTH), Enugu, were assessed using atomic absorption spectrophotometer. The levels of asthma control of children with asthma were assessed using asthma therapyassessment questionnaire (ATAQ). Mean serum magnesium levels of the different asthma control levels were compared using the analysis of variance (ANOVA).Results: The mean ages of children with asthma and those without asthma were 10.4 ± 2.98 years and 10.5 ±3.00 years respectively. The mean serum magnesium level of stable children with asthma (1.13 ±1.04 mmol/L) was found to be significantly lower than those of the non-asthmatic controls (1.46 ±1.01 mmol/L), p= 0.004.A significant association was also found between the serum magnesium levels and the levels of asthma control (p = 0.015).Conclusion: This study shows that the serum magnesium level of stable asthmatic children is significantly lower than that of children without asthma and there is a significant association between the mean serum magnesium levels and their levels of asthma control.
 Keywords: Serum magnesium, asthma control, stable asthma

Two regimens of dexamethasone versus prednisolone for acute exacerbations in asthmatic Egyptian children

IntroductionAsthma is one of the most prevalent chronic respiratory diseases, which often leads to an emergency department visit. Prednisolone is the most commonly used corticosteroid in treatment of asthma exacerbation....

Impact of shared decision making on asthma quality of life and asthma control among children

ABSTRACTObjective: Few studies have examined the effectiveness of shared decision making (SDM) in clinical practice. This study evaluated the impact of SDM on quality of life and symptom control in children with asthma. Methods: We conducted a prospective 3-year study in six community-based practices serving a low-income patient population. Practices received training on SDM using an evidence-based toolkit. Patients aged 2–17 with a diagnosis of asthma were identified from scheduling and billing data. At approximate 6-month intervals, patients completed a survey consisting of the Mini Pediatric Asthma Quality of Life Questionnaire (range 1–7) and the control domain of the Pediatric Asthma Therapy Assessment Questionnaire (range 0–7). We used propensity scores to match 46 children receiving SDM to 46 children receiving usual care with decision support. Included children had completed a baseline survey and at least one follow-up survey. Random coefficient models incorporated repeated measures to assess the effect of SDM on asthma quality of life and asthma control. Results: The sample was primarily of non-White patients (94.6%) with Medicaid insurance (92.4%). Receipt of SDM using an evidence-based toolkit was associated with higher asthma quality of life [mean difference 0.9; 95% confidence interval (CI) 0.4–1.4] and fewer asthma control problems (mean difference −0.9; 95% CI −1.6–−0.2) compared to usual care with decision support. Conclusions: Implementation of SDM within clinical practices using a standardized toolkit is associated with improved asthma quality of life and asthma control for low-income children with asthma when compared to usual care with decision support.

Evaluation of Asthma Control in Children Using Childhood- Asthma Control Test (C-ACT) and Asthma Therapy Assessment Questionnaire (ATAQ).

To evaluate the efficacy of Childhood-asthma control test (C-ACT) and the Asthma therapy assessment questionnaire by (ATAQ) checking its consistency with Global Initiative for Asthma (GINA) criteria. Asthma control of 97 children was assessed using C-ACT, ATAQ and GINA criteria separately, and their results were compared. C-ACT had better performance for evaluating control as per GINA criteria with sensitivity of 48.3%, specificity of 68.9%, and area under the receiver operative curve (ROC) of 0.647. The above parameters for ATAQ were: 93.1%, 17.2% and 0.552, respectively. A cut-off score of 20 for C-ACT is more suitable as it has maximum ROC area (0.667), and higher kappa score (0.315); P= 0.001. C-ACT can be validity used to monitor asthma control. However, the cut-off score 20 is more accurate for the Indian population. The performance of ATAQ in evaluating asthma control is not satisfactory.

Psychometric Properties of the Mini Pediatric Asthma Quality of Life Questionnaire in a US Sample.

The 13-item Mini Pediatric Asthma Quality of Life Questionnaire (MiniPAQLQ) was developed to measure asthma-specific quality of life in children. However, no validation studies have been conducted in the United States. This study aimed at determining the psychometric properties of the MiniPAQLQ in a US sample. Children aged 7-17 years and with an asthma diagnosis (n = 193) were identified from primary care clinics within an integrated healthcare system in the Southeastern United States. Participants completed surveys consisting of the MiniPAQLQ and the control module of the Asthma Therapy Assessment Questionnaire (ATAQ). Convergent validity was determined based on association between the MiniPAQLQ and ATAQ scores. Internal consistency reliability was determined from Cronbach's alpha coefficients for the MiniPAQLQ subscales (symptoms, emotions, and activities). Item-convergent validity was examined based on corrected item-total correlations. Item-discriminant validity was determined by comparing corrected item-total correlations and item-to-other-scale correlations. Floor and ceiling effects were examined based on the percentage of respondents having the lowest and highest scores on the MiniPAQLQ. A negative association was observed between quality of life scores from the MiniPAQLQ and asthma control as determined from the ATAQ, providing evidence of convergent validity. Internal consistency reliability was good with Cronbach's alpha values of above 0.8 for the MiniPAQLQ subscales. Item-convergent validity was confirmed, whereas item-discriminant validity was not confirmed. Floor effects were absent, whereas ceiling effects were present. The MiniPAQLQ possesses moderately good psychometric properties among children and adolescents in the United States and could be a useful tool for asthma management in clinical practice.

Asthma exacerbations and lung function in patients with severe or difficult-to-treat asthma

Asthma exacerbations and lung function in patients with severe or difficult-to-treat asthma

Study on level of control of bronchial asthma in a peripheral paediatric unit in Sri Lanka

Objectives: To describe the level of control of asthma and the factors associated with poorly controlled asthma in children registered at the Paediatric Clinic at Base Hospital, Kanthale in the Trincomalee District of the Eastern Province of Sri Lanka and to identify co-morbid factors associated with poorly controlled asthma.. Method: It was a prospective cross sectional study conducted in the Paediatric Clinic at Base Hospital Kanthale. Data was collected using an interviewer administered questionnaire from 88 physician diagnosed asthma patients. Asthma Therapy Assessment Questionnaire (ATAQ) was used to assess asthma control. Results: Majority of patients (75%) had poorly controlled asthma. Statistically significant associations were noted between poorly controlled asthma and incorrect inhaler technique (p Conclusions: In our study 75% had poorly controlled bronchial asthma. Poor control of bronchial asthma was significantly associated with incorrect inhaler technique, poor compliance to steroid inhaler, allergic rhinitis, gastro-oesophageal reflux disease and exposure to cigarette smoke at home. (Key words: Bronchial asthma; level of control; ATAQ questionnaire) Sri Lanka Journal of Child Health , 2014; 43 (4): 208-211 DOI: http://dx.doi.org/10.4038/sljch.v43i4.7763

Asthma Control and quality of life in school- age children in Enugu south east, Nigeria

This study set out to assess the quality-of-life of school-age children in relation to their level of asthma control. A cross-sectional descriptive study of children with asthma using the Paediatric Asthma Quality of Life questionnaire (PAQLQ) and the Asthma Therapy Assessment Questionnaire (ATAQ) to respectively assess the health-related quality of life and the level of asthma control. Ninety children with mean age of 11.8(SD, 2.8; 95% CI, 11.2 to 12.4) years, were enrolled. Fifteen children (16.7%) were well-controlled, 17 (18.9%) were partly-controlled while 58 (64.4%) had uncontrolled asthma. The mean asthma control score for all participants was 3.2 (95% CI, 2.8 to 3.7). The mean quality-of-life score was 5.3 (SD, 1.2; 95% CI, 4.9 to 5.5). The lowest score was in the symptom domain: 5.1 (SD, 1.4; 95% CI, 4.9 to 5.5), and among the 14-17 year age group (4.5 SD, 1.5; MD=1.1; p=0.002). The emotional domain was the least affected 5.4 (SD, 1.3; 95% CI, 5.1 to 5.7). Children with well-controlled asthma had the best quality-of-life scores in symptom domains: 5.6 (SD, 1.3; 95% CI, MD=0.6, p=0.63). Quality of life scores were not significant in determining asthma control (MD=0.1, p=0.98). Age was noted as the strongest quality-of-life predictor (B=-0.2, p=0.002). QOL scores are better in children with well-controlled asthma. Adolescent age group marks a period of both poor asthma control and quality of life in children with asthma.

Asthma control measurement using five different questionnaires: A prospective study

Questionnaires play a key place in the assessment of asthma control. Different questionnaires have been developed. However, it remains largely unknown whether they can be used interchangeably. We wondered whether the panel of frequently used scores would give similar measurement of asthma control. The present study aimed to assess the agreement between five specific questionnaires. In this prospective study, ninety-nine patients completed five commonly used asthma control scores: the GINA, the Asthma Control Test™, the Royal College of Physician score, the Asthma Therapy Assessment Questionnaire (ATAQ), and the Asthma Control Questionnaire(©) (ACQ). The kappa coefficient was used to assess the agreement between questionnaires. The agreement between the GINA and other scores was only moderate (kappa coefficients amounted from 0.41 to 0.60). With respect to the "controlled" level, all the other scores gave higher results than GINA. All other scores also tended to underestimate GINA "uncontrolled level". For the "partly controlled level" defined by 3 of the 5 questionnaires, ACQ identified the same percentage of patients than GINA while ATAQ overestimated this percentage. This study shows only moderate agreement between five commonly used asthma control scores. The GINA score showed the lowest percentage of controlled and the highest percentage of uncontrolled asthma. As a consequence, all these scores do not seem to evaluate the same symptoms. NCT01350661.

Evaluation of association between airway hyperresponsiveness, asthma control test, and asthma therapy assessment questionnaire in asthmatic children

Background: Achieving asthma control is a major challenge in children, otherwise symptoms perception remain poor especially at this age. The aim of this study is to evaluate the relationship between Asthma Control Test (ACTTM), Asthma Therapy Assessment Questionnaire (ATAQTM) and exercise-induced bronchospasm (EIB). Methods: We studied 80 asthmatic children. Airways hyperresponsiveness (AHR) was assessed by exercise-induced bronchospasm (Balke Protocol). Asthma control was evaluated using two questionnaires in all subjects: ACT (composed by Childhood-ACT and ACT) and ATAQ. In addition the use of short acting beta 2 agonist agents (SABAs) was assessed for each patient. Non-parametric variables were compared by Chi Square Test. Binomial logistic regression was performed to estimate the two questionnaires Odds Ratio (OR) in finding AHR. Results: We have found that ATAQ has a sensitivity and a specificity of 0.72 and 0.45 respectively; instead, ACT has a sensitivity and a specificity of 0.5 and 0.39 respectively in evaluating AHR. Patients with uncontrolled asthma according to ATAQ revealed a significant higher percentage of AHR compared with ACT (72% vs 50%, p < 0.01). Confirming this finding, patients declaring uncontrolled asthma to ATAQ have a significantly higher percentage (34%) of frequent SABAs use than the group with uncontrolled asthma to ACT (21%) (p <0.01). Binomial logistic regression shows how a test revealing uncontrolled asthma is associated with the increasing odds of having AHR according to ATAQ (OR = 3.8, p = 0.05), not to ACT (OR = 0.2, p = 0.1). Conclusions: Our results show that ATAQ reflects AHR and asthma control better than ACT. Children with uncontrolled asthma according to ATAQ have higher odds of having AHR and use of rescue medications (SABAs) compared to patients declaring uncontrolled asthma according to ACT. However both questionnaires are not sufficient alone to fully evaluate asthma control in children and it is always necessary to perform functional tests and investigate patients lifestyle, drug use and other important data that a simple questionnaire is not able to point out

Evaluation of association between airway hyperresponsiveness, asthma control test, and asthma therapy assessment questionnaire in asthmatic children

BackgroundAchieving asthma control is a major challenge in children, otherwise symptoms perception remain poor especially at this age. The aim of this study is to evaluate the relationship between Asthma Control Test (ACTTM), Asthma Therapy Assessment Questionnaire (ATAQTM) and exercise-induced bronchospasm (EIB).MethodsWe studied 80 asthmatic children. Airways hyperresponsiveness (AHR) was assessed by exercise-induced bronchospasm (Balke Protocol). Asthma control was evaluated using two questionnaires in all subjects: ACT (composed by Childhood-ACT and ACT) and ATAQ. In addition the use of short acting beta 2 agonist agents (SABAs) was assessed for each patient. Non-parametric variables were compared by Chi Square Test. Binomial logistic regression was performed to estimate the two questionnaires Odds Ratio (OR) in finding AHR.ResultsWe have found that ATAQ has a sensitivity and a specificity of 0.72 and 0.45 respectively; instead, ACT has a sensitivity and a specificity of 0.5 and 0.39 respectively in evaluating AHR. Patients with uncontrolled asthma according to ATAQ revealed a significant higher percentage of AHR compared with ACT (72% vs 50%, p < 0.01).Confirming this finding, patients declaring uncontrolled asthma to ATAQ have a significantly higher percentage (34%) of frequent SABAs use than the group with uncontrolled asthma to ACT (21%) (p <0.01).Binomial logistic regression shows how a test revealing uncontrolled asthma is associated with the increasing odds of having AHR according to ATAQ (OR = 3.8, p = 0.05), not to ACT (OR = 0.2, p = 0.1).ConclusionsOur results show that ATAQ reflects AHR and asthma control better than ACT. Children with uncontrolled asthma according to ATAQ have higher odds of having AHR and use of rescue medications (SABAs) compared to patients declaring uncontrolled asthma according to ACT. However both questionnaires are not sufficient alone to fully evaluate asthma control in children and it is always necessary to perform functional tests and investigate patients lifestyle, drug use and other important data that a simple questionnaire is not able to point out

The ACT and the ATAQ Are Useful Surrogates for Asthma Control in Resource-Poor Countries with Inadequate Spirometric Facilities

Objective. The objective of this study is to determine the utility of simple asthma control questionnaires in assessing the asthma control in our practice setting. Methods. The Asthma Control Test (ACT), Asthma Therapy Assessment Questionnaire (ATAQ), and mini Asthma Quality of Life Questionnaire (mini AQLQ) were administered to previously diagnosed asthma patients. Spirometry was performed to obtain the prebronchodilator forced expiratory volume in 1 second (FEV1). The relationship between test scores (ACT and ATAQ) and the FEV1 and mini AQLQ scores, respectively, was explored. Results. A total of 106 patients (mean age 41 ± 15.3 years, 61 (57.5%) females) participated in the study. The mean ACT score was 17 ± 5.3 and the mean ATAQ score was 1.46 ± 1.34. There was a significant positive correlation between the ACT score and FEV1% predicted indicating the improvement in asthma control when FEV1% predicted increases (Pearson’s correlation = 0.518, R2 = 0.268, p < .0001) and a negative correlation between the ATAQ score and FEV1% predicted also indicating the improvement in asthma control when FEV1% predicted increases (Pearson’s correlation = −0.516, R2 = 0.266, p < .0001). The ACT score was significantly and positively related to the mini AQLQ score signifying an improvement in quality of life with increasing ACT score (Pearson’s correlation = 0.691, R2 = 0.461, p < .0001).The ATAQ score was significantly and negatively related to the mini AQLQ score indicating an improvement in quality of life with decreasing ATAQ score (Pearson’s correlation = −0.654, R2 = 0.428, p ≤ .0001). The FEV1% predicted and the mini AQLQ score were the only significant determinants of both the ACT score and the ATAQ score. Conclusion. The ACT and ATAQ are the objective and reliable tools in determining asthma control due to their strong correlation with the FEV1 and the asthma-specific health-related quality of life. Use of either questionnaire routinely will identify more patients with poor asthma control even when spirometry services are not readily available.

Influence of Body Mass Index on Effects of a Shared Asthma Treatment Decision-Making Intervention

Asthma is a significant public health problem, with approximately 24.6 million Americans reporting current asthma in 2009 (1). Obesity prevalence has continuously increased over the last 30 years, reaching 33.8% among U.S. adults in 2007–2008 (2). A meta-analysis of prospective studies showed a dose-dependent relationship between increasing body mass index (BMI) and the risk of incident asthma (3). Understanding the influence of BMI and obesity on effectiveness of interventions to improve asthma control will help clinicians better care for obese patients with asthma. The Better Outcomes of Asthma Treatment study, a randomized controlled trial in 612 adults with poorly controlled asthma, found that a shared treatment decision-making (SDM) intervention improved controller medication adherence and clinical outcomes (4). Given the increased attention to the links between obesity and asthma, we conducted post hoc analyses to investigate whether baseline BMI modified the SDM intervention effects on asthma medication acquisition outcomes (fill/refill adherence and regimen strength) and clinical outcomes in the follow-up year. We hypothesized that obese patients would have benefitted less from the SDM intervention than did overweight or normal weight patients. Some of the results reported here were previously reported in the form of an abstract (5). Standard BMI categories were defined: normal (18.5–24.9 kg/m2, n = 132) and underweight (< 18.5 kg/m2, n = 7) combined, overweight (25–29.9 kg/m2, n = 185), and obese (≥ 30 kg/m2, n = 286).Using comprehensive pharmacy dispensing records, we computed continuous medication acquisition (CMA) indices (6–8) to measure fill/refill adherence for controller medications (inhaled corticosteroids, leukotriene modifiers, and others) and for long-acting β agonists (LABA) during the 12 months before and after randomization of individual participants. Controller and LABA medication regimen strength was measured by cumulative beclomethasone canister-equivalents (C-E) and salmeterol diskus-equivalents (D-E), respectively, using a standardized weighting methodology (9). Clinical outcome measures included the symptom subscale of the Juniper mini-Asthma Quality of Life Questionnaire (mini-AQLQ) (10), the Asthma Therapy Assessment Questionnaire (ATAQ) (11), asthma-related health care utilization, rescue medication use (via albuterol C-E), and lung function. Multivariable regression models were used to determine whether BMI modified the SDM intervention effect on these outcomes relative to usual care. Compared with the controller regimen strength among normal weight SDM patients (0.036 ± 0.02 C-E), obese (0.05 ± 0.026 C-E, P = 0.027) and overweight SDM patients (0.048 ± 0.03 C-E, P = 0.0007) negotiated a higher daily controller dose. BMI negatively modified the SDM intervention effect on controller fill/refill adherence (P = 0.04; Figure 1). The SDM-related increase in controller CMA index among obese patients, relative to obese usual care patients, was smaller than observed for the other weight groups, although still in a favorable direction (β = 0.086; 95% confidence interval [CI], −0.03 to 0.202; P = 0.15). Obese SDM patients also received a smaller intervention benefit (but still significantly better than UC) in terms of the total number of salmeterol D-E dispensed (β = 1.82; 95% CI, 0.81 to 2.84; P = 0.0005) than SDM patients in other weight groups (interaction term P = 0.04). Figure 1. Increase in controller continuous medication acquisition (CMA) associated with shared decision-making (SDM) intervention, compared with usual care, by body mass index (BMI) category. *Normal weight: n = 139; β-coefficient for SDM versus UC: P ... BMI did not significantly modify the observed beneficial SDM intervention effects on any of the clinical outcomes. Like normal weight and overweight SDM patients, obese SDM patients demonstrated significantly better clinical outcomes compared with obese patients in usual care for asthma-related health care utilization, use of rescue medication (albuterol C-E), the FEV1 and FEV1/FEV6 ratio, and the odds of reporting no asthma control problems (a score of 0) on the ATAQ scale. Although these analyses are exploratory, and thus, further research is needed, these results demonstrate that a shared decision-making approach to treatment choice can clinically benefit adult patients with poorly controlled asthma, regardless of BMI.

Evaluation of the National Heart, Lung, and Blood Institute guidelines impairment domain for classifying asthma control and predicting asthma exacerbations

BackgroundAccurate assessment of asthma control may help predict future asthma exacerbations. ObjectiveTo evaluate asthma guidelines impairment domain components as predictors of exacerbations in severe/difficult-to-treat asthma. MethodsChildren (aged 6–11 years; n = 289) and adolescents/adults (aged ≥12 years; n = 2,094) with complete baseline and 12-month data from The Epidemiology and Natural History of Asthma Outcomes and Treatment Regimens study were included. Asthma was categorized as very poorly controlled, not well-controlled, and well-controlled using impairment domain components. Effects of omitting each component on very poorly controlled and not well controlled groups were examined. Multivariable logistic regression determined the relationship of components in predicting asthma exacerbations. ResultsOmission of individual impairment domain components led to misclassification of asthma control in 11% to 39% of patients. A baseline exacerbation was the strongest independent predictor of exacerbation at month 12 in children (odds ratio = 2.94; P < .001) and adolescents/adults (odds ratio = 2.93; P < .001). In children, very poorly controlled asthma-based short-acting β2-agonist use was associated with a 2-fold higher exacerbation risk (odds ratio = 2.03; P = .011). In adolescents/adults, not well controlled or very poorly controlled asthma based on short-acting β2-agonist use (odds ratio = 1.49), lung function (odds ratio = 1.66), and the Asthma Therapy Assessment Questionnaire (odds ratio = 1.94) were also independent predictors of exacerbations (P < .001). ConclusionsAlthough the combined use of individual components of the impairment domain increases the sensitivity of identifying patients at high risk for future asthma exacerbations, specific components may be more important than others in severe/difficult-to-treat asthma. Prior exacerbations, short-acting β2-agonist use, lung function, and (in adolescents/adults) the Asthma Therapy Assessment Questionnaire were independent predictors of exacerbations.

Impact of asthma control on sleep, attendance at work, normal activities, and disease burden

The 2007 Expert Panel Report 3 asthma treatment guidelines place substantial emphasis on understanding the effectiveness of treatment strategies on outcomes such as disease control. To assess the impact of asthma control on patient-reported outcomes and disease burden in a real-world setting. Patients aged 18 to 64 years with moderate to severe asthma defined by medical and pharmaceutical use were asked to participate in a cross-sectional survey of asthma care, control, and burden. Patients were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification code for asthma, a prescription for an Expert Panel Report 3-defined controller medication (or combinations), and 24-month pre-index continuous eligibility. Patients with chronic obstructive pulmonary disease were excluded. Survey respondent data were linked to commercial health claims information to create the research database. The Asthma Therapy Assessment Questionnaire (ATAQ) was used as the measure of control. The ATAQ scores range from 0 to 4, with 0 indicating no asthma control problems. A total of 1,199 patients (73% women) completed the survey and had their claims data linked for analysis. Age, sex, and comorbidity index measures did not differ between respondents and nonrespondents. Only 12.2% of respondents scored 0 on the ATAQ, 77.0% scored 1 or 2, and 10.8% scored 3 or 4. The ATAQ scores were moderately correlated with patient-rated severity. Decreasing levels of asthma control were associated with greater prevalences of sleep problems, depression, functional impairment, and effect on work and regular activities. Approximately 88% of patients with moderate to severe asthma were not fully controlled despite anti-inflammatory drug treatment. Lack of asthma control is associated with substantial patient burden.

Asthma control – components and clinical importance

The 2006 GINA report recommends control driven treatment of asthma in children. This raises the question of how to define good asthma control. A pragmatic and short definition of asthma control could be: Resolution of symptoms and elimination of disease variability. This sounds easy to assess, but several studies have found that accurate assessment of asthma control is difficult in clinical practice. Physicians often over-estimate the level of asthma control and patients often under-report symptoms and the impact the asthma has on their daily life. A main reason for this is that accurate assessment of symptom resolution and disease variability requires assessment of a variety of outcomes such as day and night symptoms, need for rescue medication, impairment of daily activities such as school, work and participation in physical activities, frequency of exacerbations and measurement of the variability of lung function with time, either spontaneously or in association with a beta2 agonist or a provocation test such as a standardized exercise challenge. Assessment of all these outcomes in a child is complex due to communication problems with the child and the family and an unconscious adjustment of the daily lifestyle. To facilitate this accurate assessments of asthma control a variety of validated, easy to use instruments have been developed. These include the Asthma Control Test (ACT) (http://www.asthmacontrol.com), the Childhood Asthma Control Test, the Asthma Control Questionnaire (ACQ) (http://www.qoltech.co.uk/acq.html ), the Asthma Therapy Assessment Questionnaire (ATAQ) (http://www.ATAQInstrument.com), and the Asthma Control Scoring System and the Asthma Quality of Life Questionnaire. Most of these have been developed for and validated in adults, but some also exist in a version validated for paediatric use in school children. Their value in clinical practice, which may be quite different from the research setting in which they have been validated, requires further evaluation. The value and shortcomings of the various measurements and tools normally used to assess asthma control in children is discussed and the importance of using combinations of several outcomes and validated, easy to use instruments is emphasised. Due to communication problems with children and their families some objective measures should always be included in the assessment of control. A combination of the 1) Childhood Asthma Control Test, 2) three weeks of diary recordings of symptoms, rescue beta2 use and morning and evening peak expiratory flow rate and 3) a standardized exercise challenge test will detect more that 95% of uncontrolled asthma in a population seen in primary care.

Using the Pediatric Asthma Therapy Assessment Questionnaire to Measure Asthma Control and Healthcare Utilization in Children

: The usefulness of questionnaires to assess asthma control in clinical practice is recognized in recent international guidelines. While several questionnaires have been developed to measure asthma control in adults, there has been little study of the performance of such instruments in children. : To determine whether there is an association between asthma-related healthcare use and poor asthma control, as determined by categorical score on the control domain of the Asthma Therapy Assessment Questionnaire for children and adolescents (the pediatric ATAQ). : An analysis of a 1998 mailed survey of parents or caregivers of children aged 5-17 years with asthma enrolled in three large managed-care organizations in the Northeast and Midwest US was conducted. Pediatric ATAQ control domain score (reported for the past 4 weeks) was the main outcome measure. The pediatric ATAQ control domain was scored from 0 to 7, with 0 indicating no asthma control problems as measured by the questionnaire, and higher scores indicating increasing asthma problems. The hypothesis of an association between pediatric ATAQ control domain score and asthma-related healthcare use (hospitalizations, ER or urgent care facility visits, and doctor visits for worsening asthma in the past 12 months) was examined. : 406 completed surveys were received. Asthma-related hospitalizations, ER/urgent care visits, and doctor visits were reported for 38, 173, and 319 children, respectively. Of the three control score categories (0, 1-3, and 4-7), children with a control score of 4-7 were more likely to have been hospitalized (p = 0.01), to have visited the ER or urgent care facility (p < 0.0001), or to have visited a doctor (p = 0.0001) because of asthma managed care.In multivariate models including demographic variables and a measure of general health status, higher odds of ER/urgent care visits (odds ratio [OR] 3.47, 95% CI 1.92, 6.26) and doctor visits (OR 7.14; 95% CI 2.40, 21.2) was observed for children with an asthma control score of 4-7 than for children with no identified asthma control problems (score of 0). An asthma control score of 4-7 was significantly associated with hospitalization in a multivariate model including only demographic variables (OR 3.06; 95% CI 1.28, 7.33) but not in a model that included general health status (OR 2.44; 95% CI 0.96, 6.16). Relative to an excellent health status, a fair or poor health status was significantly associated with asthma-related hospitalization (OR 7.03; 95% CI 1.71, 28.87). Compared with White race, Black race was significantly associated with hospitalization (OR 2.30; 95% CI 1.05, 5.04) and ER/urgent care visits (OR 2.89; 95% CI 1.67, 5.01). : Children identified as having poor asthma control using the pediatric ATAQ instrument had significantly higher rates of asthma-related hospitalizations, ER or urgent care visits, and doctor visits than those with good control. This asthma control measure may be useful in identifying children in need of more intensive asthma management.

Impact of Asthma Controller Medications on Clinical, Economic, and Patient-Reported Outcomes

To comprehensively evaluate clinical, economic, and patient-reported outcomes associated with various therapeutic classes of asthma controller medications. This observational study, which used administrative claims data from US commercial health plans, included patients with asthma aged 18 through 64 years who filled a prescription for at least 1 asthma controller medication from September 1, 2003, through August 31, 2005. Outcome metrics included the use of short-acting beta-agonists (SABAs), the use of oral corticosteroids, inpatient (INP)/emergency department (ED) visits, and asthma-related health care costs. A subset of 5000 patients was randomly selected for a survey using the Mini-Asthma Quality of Life Questionnaire, the Work Productivity and Activity Impairment questionnaire, and the Asthma Therapy Assessment Questionnaire. Of 56,168 eligible patients, 823 returned completed questionnaires. Compared with inhaled corticosteroids (ICSs), leukotriene modifiers (LMs) were associated with lower odds of INP/ED visits (odds ratio [OR], 0.80; P<.001), lower odds of using 6 or more SABA canisters (OR, 0.81; P<.001), and higher annual cost ($193; P<.001). In the subgroup analysis of adherent patients, LMs were associated with higher odds of INP/ED visits (OR, 1.74; P=.04), lower odds of using 6 or more SABA canisters (OR, 0.46; P<.001), and higher annual cost ($235; P<.001). Inhaled corticosteroids and LMs had a comparable impact on all patient-reported outcomes. For combination therapy, ICS plus a long-acting beta-agonist consistently showed at least equivalent or better outcomes in the use of SABAs and oral corticosteroids, the risk of INP/ED visits, cost, asthma control level, quality of life, and impairment in productivity and activity. Inhaled corticosteroids were associated with a lower risk of INP/ED visits, and a lower cost if adherence was achieved. When adherence cannot be achieved, LMs may be a reasonable alternative. Combination therapy with ICS plus a long-acting beta-agonist was associated with better or equivalent clinical, economic, and patient-reported outcomes.