Can the Asthma Control Questionnaire be used to differentiate between patients with controlled and uncontrolled asthma symptoms? A pilot study.
BACKGROUND
A substantial number of adult patients with asthma are inadequately controlled despite the availability of effective asthma treatment. Patients and physicians seem to overestimate the level of asthma control.


OBJECTIVE
The current study explores whether valid differentiation is possible between asthma patients with controlled and uncontrolled asthma symptoms, on the basis of the Asthma Control Questionnaire (ACQ).


METHODS
In this multi-centre, cross-sectional study, patients were classified according to Global Initiative for Asthma criteria into levels of asthma symptom control based on a diary card registration. We defined Step 1 ('well controlled' asthma symptoms), Step 2 ('moderately controlled'), Step 3 ('poorly controlled') and Step 4 ('very poorly controlled'). These control steps were related with the sum score of the ACQ.


RESULTS
From 108 asthma patients complete data were obtained. The Step 1 subgroup comprised 17 patients; Step 2, 12 patients; Step 3, 22 patients; and Step 4, 57 patients. Receiver Operating Characteristic curve analysis showed that the optimal ACQ sum score cut-off value to differentiate between Step 1 and Steps 2, 3 and 4 was three points (sensitivity: 84%, specificity: 76%). For Steps 1 and 2 versus Steps 3 and 4, this was four points (sensitivity: 77%, specificity: 59%). For Steps 1, 2 and 3 versus Step 4, this was six points (sensitivity: 70%, specificity: 74%).


CONCLUSIONS
Our results show that discrimination between asthma patients with controlled and uncontrolled asthma symptoms, based on the ACQ, is possible with a reasonable margin of test inaccuracy. Thus, the ACQ may be an important tool for health care professionals who aim to optimize the level of asthma control in their patient population.
van den Nieuwenhof
Lotte
L
Department of Family Medicine, Radboud University Nijmegen Medical Centre, The Netherlands. L.vandennieuwenhof@hag.umcn.nl
Schermer
Tjard
T
Eysink
Petra
P
Halet
Eric
E
van Weel
Chris
C
Bindels
Patrick
P
Bottema
Ben
B
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D001993:Bronchodilator Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D013256:Steroids / Q000008:administration & dosage; D011795:Surveys and Questionnaires
D001993:Bronchodilator Agents; D013256:Steroids