Family Practice Advance Access originally published online on July 31, 2006
Family Practice 2006 23(6):674-681; doi:10.1093/fampra/cml041
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Can the Asthma Control Questionnaire be used to differentiate between patients with controlled and uncontrolled asthma symptoms? A pilot study
a Department of Family Medicine, Radboud University Nijmegen Medical Centre The Netherlands
b Division of Clinical Methods and Public Health, Department of Family Medicine, Academic Medical Centre, University of Amsterdam The Netherlands
Correspondence to Lotte van den Nieuwenhof, MD, Department of Family Medicine (117-HAG), Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Email: L.vandennieuwenhof{at}hag.umcn.nl
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%).
Conclusion. 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.
Keywords. Asthma symptoms, control, detection, family practice, questionnaire.
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