title: Validation of parental reports of asthma trajectory, burden, and risk by using the pediatric asthma control and communication instrument.
abstract: BACKGROUND
  Despite a growing interest, few pediatric asthma questionnaires assess multiple dimensions of asthma morbidity, as recommended by national asthma guidelines, or use patient-reported outcomes.
  
  
  OBJECTIVE
  To evaluate a questionnaire that measures multiple dimensions of parent-reported asthma morbidity (Direction, Bother, and Risk).
  
  
  METHODS
  We administered the Pediatric Asthma Control and Communication Instrument (PACCI) and assessed asthma control (PACCI Control), quality of life, and lung function among children who presented for routine asthma care. The PACCI was evaluated for discriminative validity.
  
  
  RESULTS
  A total of 317 children participated (mean age, 8.2 years; 58% boys; 44% African American). As parent-reported PACCI Direction changed from "better" to "worse," we observed poorer asthma control (P < .001), mean Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ) scores (P < .001), and FEV1% (P = .025). Linear regression showed that, for each change in PACCI Direction, the mean PACQLQ score decreased by -0.6 (95% CI, -0.8 to -0.4). As parent-reported PACCI Bother changed from "not bothered" to "very bothered," we observed poorer asthma control (P < .001) and lower mean PACQLQ scores (P < .001). Linear regression showed that, for each change in PACCI Bother category, the mean PACQLQ score decreased by -1.1 (95% CI, -1.3 to -0.9). Any reported PACCI Risk event (emergency department visit, hospitalization, or use of an oral corticosteroid) was associated with poorer asthma control (P < .05) and PACQLQ scores (P < .01).
  
  
  CONCLUSIONS
  PACCI Direction, Bother, and Risk are valid measures of parent-reported outcomes and show good discriminative validity. The PACCI is a simple clinical tool to assess multiple dimensions of parent-reported asthma morbidity, in addition to risk and control.
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, Calif. Electronic address: sokelo@mednet.ucla.edu.
authors.forename: Sande O
authors.initials: SO
authors.lastname: Okelo
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Eakin
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Riekert
authors.affiliation: Department of Pediatrics, New York Presbyterian/Weill Medical College of Cornell University, New York, NY.
authors.forename: Alvin P
authors.initials: AP
authors.lastname: Teodoro
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Bilderback
authors.affiliation: Department of Pediatrics, University of Colorado, Denver, Colo.
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Thompson
authors.affiliation: Division of Pediatric Pulmonology, Hospital Infantil de Las Californias, Tijuana, Mexico.
authors.forename: Antonio
authors.initials: A
authors.lastname: Loiaza-Martinez
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
authors.affiliation: Department of Pediatrics, University of California San Francisco, San Francisco, Calif.
authors.forename: Shannon
authors.initials: S
authors.lastname: Thyne
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, Calif.
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: Patino
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003142:Communication; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Burden; Children; PACCI; Patient-reported outcomes; Risk; Survey; Trajectory; Validation