Assessment Of Asthma Morbidity By Us Patients, Specialists, Asthma Control Test (Tm), And Asthma Impairment And Risk Questionnaire (Tm)

Background: Patients and healthcare providers overestimate asthma control. Aim: To evaluate US asthma patients’ and their specialty physicians’ subjective assessment of control compared to the symptom-based Asthma Control Test (ACT™) and composite Asthma Impairment and Risk Questionnaire (AIRQ™). Methods: 1113 specialist-treated patients of all severity levels aged ≥12 yrs were enrolled in a validation study of AIRQ™. AIRQ™ is a 10-item, equally weighted, yes/no tool assessing symptom impairment and risk of exacerbations with score ranges indicating well-, not well-, or very poorly controlled asthma. At entry, ACT™ and AIRQ™ were given during a comprehensive visit, and prior-year, chart-documented, severe exacerbations recorded. Patients and physicians rated control on a 5-item Likert scale (completely, well, somewhat, poorly, not controlled). Results: Mean(SD) age 44(20) yrs; 15% 12-17 yrs; 30% male, 78% white. Physicians rated 54% of patients as completely/well-controlled; 62% of evaluable patients rated themselves similarly. 49% were well-controlled per ACT™ (score ≥20) and 35% per AIRQ™ (0 or 1 yes responses). 30% of physician-rated completely/well-controlled patients and 33% of similarly self-assessed patients had ≥1 prior-year exacerbation. 30% of patients well-controlled per ACT™ and 15% per AIRQ™ had prior-year exacerbations. Thus, for patients whose scores indicated well-controlled asthma, 85% of AIRQ™ vs only 70% of ACT™ assessments correctly identified exacerbation risk. Conclusion: AIRQ™ includes impairment and risk items and provides a more comprehensive assessment of asthma control than patient and physician ratings or symptom-based tools.