Chest
Volume 122, Issue 6, December 2002, Pages 2217-2223
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Preliminary Reports
How Should We Quantify Asthma Control?: A Proposal

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Background

Current asthma guidelines suggest a series of criteria to assess if asthma is controlled. However, there is a need to develop a simple and practical method to quantify the degree of such control, both in clinical practice and research.

Study objectives

This report describes a new method to quantify asthma control based on a percentage score. It also aims at comparing the percentage scores obtained with patient’s self-evaluation of asthma control and a current validated Mini Asthma Quality of Life (MAQOL) questionnaire.

Setting and subjects

Forty-two subjects (25 female and 17 male patients) with asthma of different severity recruited from a tertiary center asthma clinic.

Methods

The asthma scoring method provided a percentage control for symptoms, baseline expiratory flows and, an optional parameter, for airway inflammation assessed from induced-sputum eosinophil count. These control parameters were compared to an overall assessment of asthma control by the patient (also on a 100% scale) and the score obtained from a validated MAQOL questionnaire.

Results

Mean ± SEM scores for symptoms, expiratory flows, and airway eosinophilia (last 2 weeks) were 87.8 ± 1.4%, 88.6 ± 1.8%, and 66.2 ± 3.9%, respectively. No significant correlation was found between these three parameters (p > 0.05). The mean global asthma control score and the score estimated by the patient were 80.9 ± 1.5% and 91.7 ± 1.5%, respectively (not significantly different). There was a significant correlation between asthma control score (percentage) and percentage symptom score (p < 0.001), while it almost achieved significance for FEV1 (p = 0.05). Only symptom scores correlated with the MAQOL questionnaire.

Conclusions

We developed a simple easy-to-use asthma control scoring system based on a percentage of optimal control. The percentage symptom score but not the global control score of this new method correlated with patient’s global assessment of asthma control. This could be a simple tool that is potentially useful both for the clinician and for research purposes, to quantify global or specific aspects of asthma control.

Section snippets

Materials and Methods

This survey was done in 42 consecutive patients (25 female and 17 male patients) with asthma of different degrees of severity attending the Laval Hospital Asthma Clinic and Clinical Research Center. Mean age was 34.8 years (SEM, 2.3). All were receiving an inhaled β2-agonist on demand (albuterol or terbutaline), 23 patients were receiving an inhaled corticosteroid (mean daily dose, 744 μg [SEM, 94]), and 7 patients were receiving a long-acting β2-agonist (salmeterol, 50 μg bid; or formoterol,

Results

The percentage control score for the last 2 weeks of clinical assessment went from 60 to 100% (mean ± SEM, 87.8 ± 1.4%) [Fig 2]. For FEV1 (percentage of optimal value, patient’s best FEV1 in percentage of predicted value), percentage control score went from 40 to 100% (mean, 88.6 ± 1.8%).

For the quality-of-life questionnaire, the global score was 5.99 ± 0.13; it was 5.83 ± 0.16 for symptoms, 6.29 ± 0.11 for activity limitation, 6.23 ± 0.14 for emotional function, and 5.63 ± 0.19 for

Discussion

The main goal of asthma treatment is to achieve adequate control of the disease in order to reduce its consequences and, ideally, its severity over time.1,2 This can be obtained through patient education, environmental control, and individualized pharmacotherapy. Although current clinical practice guidelines suggest specific criteria for assessing asthma control, and various questionnaires have been proposed to assess those criteria, there are very few methods available for globally quantifying

ACKNOWLEDGMENT

We are grateful to Mariette Veillette, Sylvie Carette, and Lori Henig Schubert for their help with the preparation of this article.

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