title: Development of a tool to recognize small airways dysfunction in asthma (SADT).
abstract: BACKGROUND
  Small airways dysfunction (SAD) contributes to the clinical expression of asthma. The identification of patients who suffer from SAD is important from a clinical perspective, as targeted therapy may improve patients' well-being and treatment efficacy.
  
  
  OBJECTIVE
  We aimed to realize the first step in the development of a simple small airways dysfunction tool (SADT) that may help to identify asthma patients having SAD.
  
  
  METHODS
  Asthma patients with and without SAD were interviewed. Patients were selected to participate in this study based on FEF50% and R5-R20 values from spirometry and impulse oscillometry respectively.
  
  
  RESULTS
  Ten in depth interviews and two focus groups revealed that patients with and without SAD perceived differences in symptoms and signs, habits and health related issues. For example, patients with SAD reported to wheeze easily, were unable to breathe in deeply, mentioned more symptoms related to bronchial hyperresponsiveness, experienced more pronounced exercise-induced symptoms and more frequently had allergic respiratory symptoms after exposure to cats and birds. Based on these differences, 63 items were retained to be further explored for the SADT.
  
  
  CONCLUSIONS
  The first step of the development of the SADT tool shows that there are relevant differences in signs and respiratory symptoms between asthma patients with and without SAD. The next step is to test and validate all items in order to retain the most relevant items to create a short and simple tool, which should be useful to identify asthma patients with SAD in clinical practice.
authors.affiliation: Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. l.schiphof@umcg.nl.|University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), A. Deusinglaan 1, 9700 AV, PO Box 196, Groningen, HPC FA 21, The Netherlands. l.schiphof@umcg.nl.
authors.forename: Lieke
authors.initials: L
authors.lastname: Schiphof-Godart
authors.affiliation: University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), A. Deusinglaan 1, 9700 AV, PO Box 196, Groningen, HPC FA 21, The Netherlands. e.van.der.wiel@umcg.nl.|Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. e.van.der.wiel@umcg.nl.
authors.forename: Erica
authors.initials: E
authors.lastname: van der Wiel
authors.affiliation: University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), A. Deusinglaan 1, 9700 AV, PO Box 196, Groningen, HPC FA 21, The Netherlands. n.h.t.ten.hacken@umcg.nl.|Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. n.h.t.ten.hacken@umcg.nl.
authors.forename: Nick H T
authors.initials: NH
authors.lastname: Ten Hacken
authors.affiliation: University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), A. Deusinglaan 1, 9700 AV, PO Box 196, Groningen, HPC FA 21, The Netherlands. m.van.den.berge@umcg.nl.|Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. m.van.den.berge@umcg.nl.
authors.forename: Maarten
authors.initials: M
authors.lastname: van den Berge
authors.affiliation: University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), A. Deusinglaan 1, 9700 AV, PO Box 196, Groningen, HPC FA 21, The Netherlands. d.s.postma@umcg.nl.|Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. d.s.postma@umcg.nl.
authors.forename: Dirkje S
authors.initials: DS
authors.lastname: Postma
authors.affiliation: Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. t.van.der.molen@umcg.nl.|University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), A. Deusinglaan 1, 9700 AV, PO Box 196, Groningen, HPC FA 21, The Netherlands. t.van.der.molen@umcg.nl.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000523:psychology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D011788:Quality of Life; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D013147:Spirometry / Q000379:methods*