Measuring asthma control: a comparison of three classification systems.
There are various ways to classify asthma control; however, no classification is universally accepted. This retrospective analysis compared asthma control as assessed by the Asthma Control Questionnaire (5-item version; ACQ-5), Global Initiative for Asthma (GINA) or Gaining Optimal Asthma Control (GOAL) study criteria. Pooled data at the final study week (n = 8,188) from three budesonide/formoterol maintenance and reliever therapy studies which measured ACQ-5 were stratified according to GINA or GOAL criteria and ACQ-5 score distribution. The percentages of patients with a controlled/partly controlled week (GINA), totally/well-controlled week (GOAL) and range of ACQ-5 cut-off points were compared. Patients with GINA controlled, partly controlled and uncontrolled asthma had mean ACQ-5 scores of 0.43, 0.75 and 1.62, respectively. Patients with GOAL totally controlled, well-controlled and uncontrolled asthma had ACQ-5 scores of 0.39, 0.78 and 1.63. The kappa measure of agreement was 0.80 for GINA and GOAL criteria, and 0.63 for GINA controlled/partly controlled and ACQ-5 <1.00. ACQ-5 detected clinically important improvements in 49% of patients who, according to GINA criteria, remained uncontrolled at the end of the study. Asthma control measured by GINA or GOAL criteria provides similar results. GINA Controlled/Partly Controlled and GOAL Totally Controlled/Well-Controlled correspond to ACQ-5 <1.00. The ACQ-5 is more responsive to change in a clinical trial setting than a categorical scale.
O'Byrne
P M
PM
Michael G DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. obyrnep@mcmaster.ca
Reddel
H K
HK
Eriksson
G
G
Ostlund
O
O
Peterson
S
S
Sears
M R
MR
Jenkins
C
C
Humbert
M
M
Buhl
R
R
Harrison
T W
TW
Quirce
S
S
Bateman
E D
ED
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001249:Asthma / Q000145:classification* / Q000175:diagnosis*; D019819:Budesonide / Q000494:pharmacology; D002648:Child; D004311:Double-Blind Method; D004983:Ethanolamines / Q000494:pharmacology; D005260:Female; D000068759:Formoterol Fumarate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015272:Pulmonary Medicine / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors
D004983:Ethanolamines; D019819:Budesonide; D000068759:Formoterol Fumarate