title: ALMA, a new tool for the management of asthma patients  in clinical practice: development, validation and initial  clinical findings.
abstract: BACKGROUND
  Several instruments have been developed for measuring asthma control, but there is still a need to provide a structure for  primary care asthma reviews.
  
  
  OBJECTIVE
  The Active Life with Asthma (ALMA) tool was developed with the aim of structuring patient visits and assessing asthma treatment  in primary care. The ability of ALMA to map out the care of asthma patients was evaluated and validated.
  
  
  METHODS
  ALMA was developed with patient and clinical expert input. Questions were generated in focus groups and the resulting tool  was subsequently validated by factor analysis in 1779 patients (1116 females) of mean age 51 years (range 18-89) in primary care.
  
  
  RESULTS
  The ALMA tool includes 19 questions, 14 of which belong to a subset assessing asthma control. In this subset, factor analysis  revealed three domains (factors): physical, psychological, and environmental triggers. Correlation with the Asthma Control Questionnaire  was 0.72 and the Cronbach's alpha was 0.88. The test-retest reliability was 0.93. Of the 1779 patients tested with ALMA in primary care,  62% reported chest tightness, 30% nightly awakenings and 45% asthma breakthrough despite medication.
  
  
  CONCLUSIONS
  The ALMA tool is useful as a follow-up instrument in clinical practice to structure patient visits and assess asthma treatment  in primary care. The breadth of the questions and the pragmatic use in clinical practice also make it useful as an outcome measure.
authors.affiliation: Skåne University Hospital, Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Lund University, Sweden.
authors.forename: Hampus
authors.initials: H
authors.lastname: Kiotseridis
authors.forename: Leif
authors.initials: L
authors.lastname: Bjermer
authors.forename: Eva
authors.initials: E
authors.lastname: Pilman
authors.forename: Björn
authors.initials: B
authors.lastname: Ställberg
authors.forename: Kerstin
authors.initials: K
authors.lastname: Romberg
authors.forename: Alf
authors.initials: A
authors.lastname: Tunsäter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D003661:Decision Support Techniques; D005163:Factor Analysis, Statistical; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult