Different Levels Of Asthma Control Research Articles

Quality of life of patients with asthma: the effects of overweight, obesity and multimorbidity

BACKGROUND: Despite significant progress in the search for treatable additional features affecting multicomponent control of bronchial asthma, there is currently a paucity of research studies with a comprehensive assessment of the impact of obesity and multimorbidity on quality of life in patients with bronchial asthma. AIM: To assess the effect of personalizing features (obesity and multimorbidity) on the quality of life of patients with different levels of asthma control. MATERIALS AND METHODS: Patients with asthma (n = 237) were divided into 3 groups depending on BMI. Multimorbid pathology was analyzed by Cumulative Illness Rating Scale (CIRS), asthma control — Asthma Control Questionnaire-5 (ACQ-5), quality of life — Asthma Quality of Life Questionnaire with Standardized Activities [AQLQ(S)], anxiety and depression — Hospital Anxiety and Depression Scale (HADS). Statistical analysis: Microsoft Excel, Statistica 12.0, Statgraphics XVIII. RESULTS: Patients with obesity and asthma had more comorbidities (p 0.05). Quality of life in patients with high and normal body weight depended on the level of control and the number of diseases (p 0.05), with getting worse disease control these differences became insignificant. In the group with obesity, activity limitation (p = 0.0150) and overall quality of life (p 0.005) increased significantly with increasing number of diseases. Anxiety levels increased with increasing number of illnesses (p 0.0001). Quality of life of patients according to AQLQ(S) has inverse correlation with BMI (r = −0.5135), age (r = −0.2034) with CIRS scores (r = −0.4905) with anxiety (r = −0.5078) and depression (r = −0.4820) level. CONCLUSIONS: Body weight, level of asthma control, depression and anxiety, and the number of comorbid multimorbid conditions affect the quality of life of patients with asthma. Obesity makes a significant negative contribution to worsening asthma control and patients’ quality of life, in this group patients have the highest level of multimorbidity and they have a prevalence of anxiety. To improve asthma control, patients need a complex examination including assessment of quality of life, depression and anxiety, and comorbidities in order to develop personalization of therapeutic approaches to patient management.

Validation of the German version of the Asthma Impairment and Risk Questionnaire (AIRQ).

The Asthma Impairment and Risk Questionnaire (AIRQ), a 10-item, equally weighted, yes/no tool assessing symptom impairment and risk of exacerbations in patients with asthma aged ≥12 years, was developed and validated in a US patient population to evaluate varying levels of asthma control. This study aimed to validate the German language version of the AIRQ in patients aged ≥12 years with different levels of asthma control. A cross-sectional, observational, multi-centre study comprising a single visit was conducted in multiple specialised asthma centres and general practices in Germany. A total of 300 patients completed the following measures: 1) Patient Sociodemographic and Clinical Questionnaire, 2) AIRQ, 3) Asthma Control Test (ACT), and 4) Asthma Control Questionnaire (ACQ-6). Logistic regression analyses were conducted to assess the AIRQ score cut points with the greatest predictive validity in discriminating between different control levels relative to a standard of ACT plus prior-year exacerbations or ACQ-6 plus prior-year exacerbations. The German version of the AIRQ demonstrated a robust capability to correctly identify well-controlled versus not well- or very poorly controlled (AUC values of 0.90 or higher) and well- or not well-controlled versus very poorly controlled asthma (AUC values of 0.89 or higher). The German version of the AIRQ is a suitable tool to identify adults with varying levels of asthma control, which in turn can help to accurately identify patients with uncontrolled asthma in clinical practice.

1-Year Prospective Study of the Relationship of Serial Exhaled Nitric Oxide Level and Asthma Control.

Previous studies found that the fractional nitric oxide concentration in exhaled breath (FeNO) levels in healthy Chinese adults was higher than in White adults. More understanding of serial changes of FeNO levels with asthma control in a real-life clinical setting would be important to explore the utility of this biomarker in routine asthma management. This study assessed the FeNO levels of Chinese asthma subjects with different levels of asthma control and the serial changes with respect to the changes in asthma control over 1 year. A 12-month prospective study (subjects recruited between November 2019 and January 2021) with serial measurement of FeNO levels at baseline, 4, 8 and 12 months. Asthma control was assessed by the Global Initiative for Asthma classification, Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ). Altogether, 136 subjects (mean age 51.51±15.09 years, 46[33.8%] male) had successful baseline FeNO measurements. At baseline, the FeNO levels did not show a statistically significant difference for controlled, partly controlled and uncontrolled asthma according to GINA classification, ACT and ACQ. FeNO levels decreased with improving asthma control and stayed at similar levels with unchanged or worsening asthma control for all subjects. For subjects with baseline blood eosinophil levels ≥300 cells/µL(n=59), FeNO levels decreased with improving asthma control, stayed similar without change for asthma control and increased with worsening asthma control. Receiver operating characteristic (ROC) analysis with the highest area under curve (AUC) for changes in FeNO levels for improving asthma control was between ≤ -10 to -25 ppb at various time points in the 12-month study. Changes in FeNO levels over time were associated with changes in clinical asthma control, particularly in those with higher blood eosinophil count and are likely more useful than a single time point measurement in managing asthma.

Intestinal Microbes-based Analysis of Immune Mechanism of Childhood Asthma.

This work was developed to explore the relationship between intestinal microflora composition and immune function changes in children with asthma and to provide theoretical references for clinical diagnosis and treatment. Forty-eight children with asthma who received standardized treatment in the outpatient department of pediatric respiratory asthma in Children's Hospital were selected as the research objects, which were rolled into 24 cases of S0 group (complete control) and 24 cases of S1 group (incomplete control group). In addition, ten healthy children with general data matching the research objects were selected as a blank control (D0 group). The intestinal microbial composition and immune function indexes of each group were detected. The results showed that there were differences in the intestinal microbes of the three groups of children with Bifidobacterium, Megasphaera, Oscillibacter, Bilophila, and f_Ruminococcaceae. Among them, the proportions of Bifidobacterium, Megasphaera, and f_Ruminococcaceae in the intestinal microbes of the children in the S1 group were notably less than those in the S0 and D0 groups. The proportion of these three bacterial genera in the S0 group was also considerably smaller than that in the D0 group (P<0.05). In addition, the CD3+ levels of children in the S1 group were notably lower than those in the S0 and D0 groups, while the CD4+ and CD4+/CD3+ were higher than the S0 and D0 groups (P<0.05). The differences between CD3+, CD4+, and CD4+/CD3+ in the S0 and D0 groups were not considerable (P<0.05). The proportions of Bifidobacterium, Megasphaera, f_Ruminococcaceae, and Parasutterella in children with intestinal microbes were significantly positively correlated with CD3+ levels (P<0.05), and significantly negatively correlated with CD4+ and CD4+/CD3+ levels (P<0.05). In short, children with different levels of asthma control had a certain degree of flora disorder and decreased immune function in the intestinal flora. The decrease in the relative abundance of Bifidobacterium, f_Ruminococcaceae of Firmicutes, and Parasutterella of Riken Bacteria, and the increase in the relative abundance of Oscillatoria meant the decline of the immune function of the children.

Impact of obstructive sleep apnea and sleep parameters on level of asthma control

Background and Objective: Several studies support high prevalence of obstructive sleep apnea (OSA) symptoms in patients with asthma. Our objective was to evaluate the relationship between OSA severity and level of asthma control if any and analyze sleep parameters in patients having different levels of asthma control. Methods: A cross-sectional study among asthma patients having symptoms of sleep-related breathing disorders. Eligible patients were assessed clinically and with sleep questionnaire including asthma control followed by level 1 Polysomnography. Results: Among 53 patients of asthma (mean age 48.16 years), OSA was present in 84.21% of uncontrolled asthma, 35% in partially controlled asthma, and 7.14% in well-controlled asthma. Uncontrolled asthma patients were associated with higher apnea/hypopnea index (AHI) (30.8±17.6 vs. 3.7±1.2; p-value < 0.0001), more time spent in non rapid eye movement (NREM) 1 stage (18.5±11.9% vs. 13.0±11.2% of total sleep time), higher nocturnal desaturation episodes (152.5±13 vs. 22.1±16.7; p-value < 0.001), and severe OSA in supine position (AHI 33.1±17.7 vs. 9.2±9.7; p-value < 0.001) compared with well-controlled asthma. Conclusion: There seems a strong relationship between desaturation events and higher AHI with poor level of asthma control, especially during supine position. OSA must be suspected in patients with uncontrolled asthma. An early detection and treatment of OSA may improve the level of asthma control as well as quality of life in such patients.

The eosinophilic and neutrophilic counts in sputum of asthmatic Iraqi patients and its correlation with asthma control

Background: Asthma control is very critical guide for therapy according to the current asthma guidelines. The asthma control test (ACT) was successfully used to assess the control level. However, variation in clinical features which composite the items of the test does not always associate with the extent of the structural changes in pulmonary airways. Thus, there is a necessity for the surrogate marker to assess the control level. Eosinophilic and neutrophilic cells have an important role in the pathological process of asthma. Aims: The aim of this study is to assess the sputum eosinophil and neutrophils as a discriminative marker between different levels of asthma control. Patients and Methods: This cross-sectional study included 88 asthmatic patients. Only 50 patients produced sputum. Demographic data, ACT parameters took from patients. Spirometer test has been done. Sputum study includes processing of sputum, counting of sputum total white cell were done. Results: According to sputum cells count and differentiation, 64% eosinophils, 10% neutrophils, 6% mixed and 20% was paucigranulocytic (non). Eosinophilic phenotype patients were poorly control with a statistically significant difference. While neutrophilic phenotype was nonstatistically significant difference. Conclusions: The most common type of asthma phenotyping is eosinophil which in turn correlated with poor asthma control while other types like neutrophil are not correlated.

Novel pharmacist-led intervention secures the minimally important difference (MID) in Asthma Control Test (ACT) score: better outcomes for patients and the healthcare provider

IntroductionA key priority in asthma management is achieving control. The Asthma Control Test (ACT) is a validated tool showing a numerical indicator which has the potential to provide a target...

Asthma control and productivity loss in those with work-related asthma: A population-based study

ABSTRACTObjective: In Canada, asthma is the third leading cause of work loss, yet little is known about the associated productivity loss. The goal of this study was to look at the relationship between asthma control and productivity loss, particularly contrasting those with work-related asthma (WRA) and non-work-related asthma (NWRA). Methods: A population-based random sample of adults with asthma in British Columbia, Canada, was prospectively recruited. Asthma control was graded according to Global Initiative for Asthma classification, while productivity loss and presence of WRA was assessed using questionnaires. Ordinal regression models were then used to associate WRA with asthma control. Generalized linear models were applied to estimate the average productivity loss associated with different levels of asthma control among those with WRA and NWRA. Results: The study included 300 employed adults. Sixty (20%) had WRA. The odds of being controlled were significantly lower in those with WRA (OR = 0.23, 95% CI: 0.09, 0.56; P < 0.01). Those with WRA and uncontrolled asthma had a significant difference in productivity loss due to presenteeism ($659.1 [95% CI: 12.9, 1581.5; P = 0.04]), but not absenteeism ($88.7 [95% CI: −86.5, 279.6; P = 0.35]), when compared to those with NWRA and uncontrolled asthma. There was no significant difference when a similar comparison was made for those with controlled or partially controlled asthma. Conclusions: WRA is associated with worse asthma control and increased productivity loss. Presenteeism makes a significant contribution to productivity loss and should be considered when evaluating the overall economic burden of asthma, particularly WRA.

Psychological dysfunctions in women with bronchial asthma

Background. The importance of psychosocial factors in the management of bronchial asthma (BA) is discussed in clinical guidelines, including in international and national clinical guidelines. However, a specific evaluation of their role as a cause of poor asthma control in susceptible patients is required. Aim. Assessment of psychological health of women with different levels of asthma control. Materials and methods. The study included 108 women with asthma observed in Saratov center for Allergology who were stratified into 3 groups according to the control level (good, partial, uncontrolled, according to GINA). In establishing a diagnosis of asthma, standard methods were used (medical history, symptoms, spirography). To assess the level of control, ACQ-5 (Asthma Control Questionnaire 5 items-self-administered) was used, to assess the quality of life, questionnaires AQLQ-S (Asthma Quality of Life Questionnaire S); SF-36 (36-ltem MOS Short-Form Health Survey), a standardized and validated Russian version of the women’s health questionnaire WHQ (Women’s Health Questionnaire) were used; for psychological diagnosis and evaluation of social and personal competencies that contribute to the preservation and improvement of human health (the intellectual, personal, emotional, physical, social, creative, spiritual aspects), integrated multimodal questionnaire was used. The comparison was conducted with a control group of men with bronchial asthma, comparable in age and level of control. Results. Women with poorly controlled asthma had worse performance of AQLQ-S (combined median score of 3,43 instead of 5,13 in the group of good control; p < 0,05); all scales of the SF-36, including the general condition (43,48 against 55,07), role of physical (25,93 against 57,76) and emotional problems (43,83 against 64,37); at p < 0.05. According to the WHQ questionnaire (the inverse relationship: the higher the score, the lower the quality of life) in the group with poor control there is a high level of depression (mean 0,36 versus 0,24; p < 0,05); physical health problems are marked (0,47 against 0,27; p < 0,05). There is a very low selfestimation of their attractiveness in BA (0,71 and 0,64 for bad and good control, respectively). According to the integrated multimodal questionnaire, in both men and women with asthma almost identical results were obtained on the scales sensitive to manifestations of anxiety-depressive symptoms, emotional balance, scales of emotional skills, correlating with severe alexithymia and low capacity for reflection. Among women the proportion of individuals with high scores of intellectual functioning, strong-willed competence, goal-setting, and ability of making contacts was higher. Conclusion. The severity of asthma and disease control are closely linked with the psychological condition of the patient. Psychological dysfunctions are correlated with suboptimal BA control. It is important to understand psychological differences in women and to educate patients in both effective BA control and in establishing individualized asthma management strategies.There is a need for a multidisciplinary approach aimed at the identification and effective correction of asthma. The study of the psychological characteristics of personality and motivational sphere of the patient can help to optimize therapy, improve monitoring and prognosis of the disease.

Endoscopic prevalence of different grades of gastroesophageal reflux in adult asthmatics with or without reflux symptoms

Gastroesophageal reflux and asthma often coexist in the same patient. Persons with asthma are particularly prone to asymptomatic gastroesophageal reflux disease (GERD). Esophageal pH-probe studies have documented that 32–84% of the asthmatics have abnormal acid reflux. The endoscopic assessment of esophageal mucosal changes in patients with reflux symptoms is important to diagnose patients with various degrees of severity. The aim of the study was to detect the prevalence of different grades of GERD in adult asthmatics with or without GERD symptoms by using upper gastrointestinal endoscopy. This study included 50 adult patients with different levels of asthma control according to the Asthma Control Test scoring system. Patients were classified into two groups (symptomatic and less symptomatic) according to the GERD questionnaire. All patients were blindly subjected to upper gastrointestinal endoscopy. Endoscopic grading was carried out using the Los Angeles grading system for GERD. GERD was endoscopically detected in 36 patients out of 50 (72%); most of them presented with grade B gastroesophageal reflux (28%). No significant difference was observed in GERD prevalence related to the level of asthma control (P=0.98). No significant difference was observed in endoscopic GERD prevalence between symptomatic and less symptomatic groups (P=0.53). GERD with variable grades is prevalent endoscopically among adult asthmatics at all levels of asthma control with no difference between symptomatic and less symptomatic groups.

Pattern of vitamin D in patients with chronic obstructive pulmonary diseases and in patients with bronchial asthma

ObjectiveTo determine the prevalence of vitamin D deficiency in patients with COPD and bronchial asthma, and the relation of vitamin D serum levels to pulmonary spirometric measures as well as other important clinical parameters that could affect quality of life in these patients. Subjects and methodsThe study included 80 subjects: 30 patients with COPD and 30 patients with bronchial asthma and 20 healthy volunteers. Patients and control groups were subjected to vitamin D assay by ELISA as well as spirometric assessment. Assessment of patients with COPD was done according to GOLD guidelines 2013: using (mMRCs), CAT score, spirometric assessment of FEV1, and exacerbation assessment. They were also subjected to Combined COPD assessment and BODE index calculation. For all patients with bronchial asthma, GINA classification 2014 of bronchial asthma severity and asthma control assessment were done. ResultsStatistically significant lower values of vitamin D were found in patients with COPD (11.94±7.66ng/ml) compared to patients with bronchial asthma (22.03±8.19ng/ml) with p<0.001, while mean±SD values of 25-hydroxy vitamin D of both groups of patients (COPD and bronchial asthma) were statistically significant lower than control group (35.21±6.04ng/ml) with (p2, p3<0.001) respectively. Seventeen patients that is to say (56.7%) of patients with COPD and 11 patients that is to say (36.7%) patients with bronchial asthma demonstrated a mild to moderate degree of vitamin D deficiency, whereas 13 that is to say (43.3%) patients of COPD and 4 that is to say (13.3%) patients with bronchial asthma showed severe deficiency and all control subjects (n=20) had a normal concentration of 25-hydroxy vitamin D. Statistically significant positive correlation was found between serum level of 25-hydroxy vitamin D and FEV1% of predicted in patients with COPD with (p=0.002), whereas no statistically significant correlation was found between serum level of 25-hydroxy vitamin D and FEV1% of predicted in patients with bronchial asthma with (p=0.120). Statistically significant negative correlations existed between serum level of 25-hydroxy vitamin D and exacerbation risk of patients with COPD and bronchial asthma with (rs=−0.481 and p=0.007), and (rs=−0.496 and p=0.005), respectively. Statistically significant negative correlations were found between serum level of 25-hydroxy vitamin D and exacerbation risk of patients with COPD and bronchial asthma with (rs=−0.481 and p=0.007), and (rs=−0.496 and p=0.005), respectively. Regarding relation between vitamin D level and grading severity of COPD, we found a significant correlation between serum 25-hydroxy vitamin D level and severity of COPD as assessed by GOLD spirometric classification, with decreased serum level of vitamin D as gold severity increased (19.12±4.37, 9.97±7.64, 8.21±5.72ng/ml) in gold I, II, III respectively with p=0.012. Also it was found that CAT score increased and got worse as serum level of vitamin D decreased (16.65±6.98, 8.68±2.27, 9.01±5.67ng/ml) in categories II, III, IV respectively with rs=−0.468 and p=0.034, and according to Combined COPD assessment, vitamin D levels were (19.78±4.66, 17.38±4.59, 6.75±4.77, 7.56±5.83ng/ml) in groups A, B, C and D respectively with rs=−0.448 and p=0.001. A statistically significant negative correlation was found between serum 25-hydroxy vitamin D level and BODE index score of COPD assessment with rs=−0.421, p=0.020. According to the correlation of bronchial asthma severity and control to serum level of 25-hydroxy vitamin D, we found a statistically significant negative correlation between mean±SD of serum level of 25-hydroxy vitamin D and different levels of asthma control with (rs=−0.636, p<0.001) as well as a statistically significant negative correlation between quantification of 25-hydroxy vitamin D and levels of asthma severity with (rs=−0.875, p<0.001). ConclusionVitamin D deficiency was highly prevalent in COPD and bronchial asthma (100% and 50%) respectively. Low levels of vitamin D were associated with low FEV1%, frequent exacerbations in patients with COPD and bronchial asthma, and increased COPD severity as assessed by GOLD guidelines. Important statistically significant negative associations between vitamin D level and both asthma control and asthma severity according to GINA classification were also found. Thus it is advised to include vitamin D levels in the routine assessment of patients with bronchial asthma and COPD, as well as studying the importance and clinical impact of oral supplementation of vitamin D in patients with COPD and bronchial asthma should be an important goal of future research.

THE IMPORTANCE OF ASSESING PSYCHOSOCIAL FUNCTIONS OF ASTHMATIC PATIENTS AND THEIR FAMILIES AS A COMPREHENSIVE ASTHMA CONTROL ASSESSMENT: A CASE CONTROL STUDY IN IRAN

ABSTRACT The present study was conducted to compare the physical and psychosocial functions of asthmatic patients presenting at different levels of asthma control to that of healthy children in Iran. The aim was to determine if a correlation could be made between the two thus suggesting that the level of asthma control can be used as an indirect indicator for the level of psychosocial impact. A case-control study involving 160 asthmatic children aged between 8 to 12 years-old, in comparison to an age-sex matched healthy control group was thus conducted. The result demonstrates that asthmatic children are more likely to have emotional dysfunction associated with their disease. This in turn resulted in significantly negative effects on the parents� daily working activities. The PedsQL scale which categorizes asthmatic children into three levels of asthma (controlled, partly-controlled and uncontrolled asthma) demonstrated significant differences in their Physical Function scale scores (p<0.05). However, no significant correlation between asthma control to Emotional, Social and School Functioning levels were found. In conclusion, the present study suggests that asthma not only impairs the Physical and Emotional functions of asthmatic children, but also affects their parents� daily working activity. Tightening asthma control did not appear to improve the social functioning levels of these children although it does result in improved physical function. Therefore the level of asthma cannot be used as an indicator of heightened psychosocial impact. However, the authors of this paper would warrant that treating physicians should consider incorporating the psychosocial aspect of asthmatic children and their families in their treatment plan rather than aiming for only asthma control since this appears to be an important aspect of patient care.

The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analysis

Currently, the cornerstone of asthma management is the achievement and maintenance of optimal asthma control, but the diagnostic performances of the Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) have not been evaluated systematically. We explored the diagnostic performances of and statistically compared the ACT and ACQ. Studies that examined the accuracy of the ACT, ACQ, or both in the assessment of asthma control were found by searching PubMed, CENTRAL, Web of Science, Ovid, and Embase. Summary estimates of sensitivity, specificity, and diagnostic odds ratios for the different levels of asthma control were determined by using bivariate random-effects models and hierarchical summary receiver operating characteristic models. Twenty-one studies with 11,141 subjects assessed with the ACT and 12,483 assessed with the ACQ were identified. The ACT had good diagnostic accuracy for assessment of controlled and not well-controlled asthma, and the ACQ (ACQ-7 and ACQ-6) had good diagnostic accuracy for assessment of not well-controlled asthma at prespecified cutoff points. The ACT and ACQ had significant differences in the assessment of controlled and not well-controlled asthma after adjusting for potential factors (P = .001 and P = .015). For assessment of uncontrolled asthma, the ACT had poor accuracy, with a hierarchical summary receiver operating characteristic area under the curve of 0.69, and the cutoff point for the ACQ has not been established. The ACT is preferable to the ACQ in clinical practice, and the ACQ requires further cross-validation. Moreover, neither the ACT nor the ACQ is useful for the assessment of uncontrolled asthma.

Cost-Effectiveness and Cost-Utility of Beclomethasone/Formoterol versus Fluticasone Propionate/Salmeterol in Patients with Moderate to Severe Asthma

Asthma is a chronic disease characterized by acute symptomatic episodes with variable severity and duration. Pharmacological asthma management aims to achieve and maintain control without side effects, thus improving quality of life and reducing the economic impact. Recently, a clinical trial showed the non-inferiority of beclomethasone/formoterol (BDP/F) versus fluticasone propionate/salmeterol (FP/S) in adults with moderate to severe persistent asthma. However, this study did not provide evidence on costs and did not quantify quality-of-life parameters. The objective of the present study was to assess the cost effectiveness and cost utility of BDP/F versus FP/S in patients with moderate to severe asthma from the perspective of the Italian National Health Service (NHS). A Markov model (MM) was used, with five health states for the different levels of asthma control: successful control, sub-optimal control, outpatient-managed exacerbation, inpatient-managed exacerbation, and death. Model data were derived from the ICAT SE study and from expert panels. Three outcomes were considered: time spent in successful control state, costs and quality-adjusted life-years (QALYs). The model shows that BDP/F treatment led to a slight increase of weeks in successful control compared with FP/S, with a lower cost. The probabilistic sensitivity analysis highlights that in 64% and 68% of the Monte Carlo simulations, BDP/F outperformed FP/S in terms of weeks in successful control and QALYs. Considering the expected cost of the two strategies, in 90% of simulations BDP/F was the least expensive choice. In particular, BDP/F was cost saving as compared with FP/S in about 63% and 59% of simulations as shown by the cost-utility and cost-effectiveness analysis, respectively. Overall, from the Italian NHS perspective, BDP/F treatment is associated with a reduction in cost and offers a slight increase of effectiveness in terms of weeks spent in successful control and QALYs.

Evaluation, Modification and Validation of a Set Of Asthma Illustrations in Children with Chronic Asthma in the Emergency Department

To test, modify and validate a set of illustrations depicting different levels of asthma control and common asthma triggers in pediatric patients (and⁄or their parents) with chronic asthma who presented to the emergency department at the Children's Hospital of Eastern Ontario, Ottawa, Ontario. Semistructured interviews using guessability and translucency questionnaires tested the comprehensibility of 15 illustrations depicting different levels of asthma control and common asthma triggers in children 10 to 17 years of age, and parents of children one to nine years of age who presented to the emergency department. Illustrations with an overall guessability score <80% and⁄or translucency median score <6, were reviewed by the study team and modified by the study's graphic designer. Modifications were made based on key concepts identified by study participants. A total of 80 patients were interviewed. Seven of the original 15 illustrations (47%) required modifications to obtain the prespecified guessability and translucency goals. The authors successfully developed, modified and validated a set of 15 illustrations representing different levels of asthma control and common asthma triggers. These illustrations will be incorporated into a child-friendly asthma action plan that enables the child to be involved in his or her asthma self-management care.