Mayo Clinic Proceedings Home

Comparing the Asthma APGAR System and the Asthma Control Test™ in a Multicenter Primary Care Sample

      Abstract

      Objective

      To compare asthma control assessment using the Asthma APGAR system, a tool developed by primary care clinicians, in a multicenter primary care sample with the Asthma Control Test (ACT™)/Childhood Asthma Control Test (CACT™), a tool developed by asthma specialists.

      Patients and Methods

      This is a substudy of a multicenter, randomized, controlled pragmatic trial that tests the effectiveness of the Asthma APGAR system in primary care practices. As part of the study, enrolled patients completed both the ACT™/CACT™ and the Asthma APGAR system between March 1, 2011, and December 31, 2011. Kappa and McNemar statistics were used to compare the results of questionnaires.

      Results

      Of the 468 patients in our sample, 306 (65%) were classified as not controlled by the ACT™/CACT™ or the Asthma APGAR system. The overall agreement was 84.4%, with a kappa value of .68 (substantial agreement) and a McNemar test P value of .35 (suggesting no significant difference in the direction of disagreement). Of those with poor control as defined by the Asthma APGAR system, 23.8% (73) had no controller medications and 76.5% (234) were seldom or sometimes able to avoid identified triggers for their asthma. Of those who stated that they had been prescribed controller medications, 116 of 332 (35%) stated that they did not use the controller medication on a daily basis.

      Conclusion

      The Asthma APGAR system and the ACT™/CACT™ similarly assess asthma control in a multicenter primary care–based sample. The Asthma APGAR system identified an “actionable item” in more than 75% (234) of the individuals with poor asthma control, thus linking an assessment of poor asthma control with a management strategy.

      Abbreviations and Acronyms:

      ACT™ ( Asthma Control Test), ACQ ( Asthma Control Questionnaire), AQLQ ( Asthma Quality of Life Questionnaire), CACT™ ( Childhood Asthma Control Test), GINA ( Global Initiative for Asthma), IRB ( institutional review board), PAQLQ ( Pediatric Asthma Quality of Life Questionnaire)
      To read this article in full you will need to make a payment

      References

      1. Guidelines for the diagnosis and management of asthma (EPR-3). National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/asthma/. Accessed July 11, 2012.

        • Yawn B.P.
        • Bertram S.
        • Wollan P.
        Introduction of asthma APGAR tools improve asthma management in primary care practices.
        J Asthma Allergy. 2008; 1: 1-10
        • van den Nieuwenhof L.
        • Schermer T.
        • Heins M.
        • et al.
        Tracing uncontrolled asthma in family practice using a mailed asthma control questionnaire.
        Ann Fam Med. 2008; 6: S16-S22
        • Nathan R.A.
        • Sorkness C.A.
        • Kosinski M.
        • et al.
        Development of the asthma control test: a survey for assessing asthma control.
        J Allergy Clin Immunol. 2004; 113: 59-65
        • Juniper E.F.
        • O’Byrne P.M.
        • Guyatt G.H.
        • Ferrie P.J.
        • King D.R.
        Development and validation of a questionnaire to measure asthma control.
        Eur Respir J. 1999; 14: 902-907
        • Yawn B.P.
        • Brenneman S.K.
        • Allen-Ramey F.C.
        • Cabana M.D.
        • Markson L.E.
        Assessment of asthma severity and asthma control in children.
        Pediatrics. 2006; 118: 322-329
        • Vollmer W.M.
        • Markson L.E.
        • O’Connor E.
        • Frazier E.A.
        • Berger M.
        • Buist A.S.
        Association of asthma control with health care utilization: a prospective evaluation.
        Am J Respir Crit Care Med. 2002; 165: 195-199
        • Schatz M.
        • Sorkness C.A.
        • Li J.T.
        • et al.
        Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists.
        J Allergy Clin Immunol. 2006; 117: 549-556
        • Heard A.R.
        • Richards I.J.
        • Alpers J.H.
        • Pilotto L.S.
        • Smith B.J.
        • Black J.A.
        Randomized controlled trial of general practice based asthma clinics.
        Med J Aust. 1999; 171: 68-71
        • Pilotto L.S.
        • Smith B.J.
        • Heard A.R.
        • McElroy H.J.
        • Weekley J.
        • Bennett P.
        Trial of nurse-run asthma clinics based in general practice versus usual medical care.
        Respirology. 2004; 9: 356-362
        • Backer V.
        • Bornemann M.
        • Knudsen D.
        • Ommen H.
        Scheduled asthma management in general practice generally improves asthma control in those who attend.
        Respir Med. 2012; 106: 635-641
        • Davis S.Q.
        • Krishnan J.A.
        • Lee K.
        • Persky V.
        • Naureckas E.T.
        Effect of a community-wide asthma intervention on appropriate use of inhaled corticosteroids.
        J Urban Health. 2011; 88: 144-155
        • Nelson K.A.
        • Highstein G.R.
        • Garbutt J.
        • et al.
        A randomized controlled trial of parental asthma coaching to improve outcomes among urban minority children.
        Arch Pediatr Adolesc Med. 2011; 165: 520-526
        • Shah S.
        • Sawyer S.M.
        • Toelle B.G.
        • et al.
        Improving paediatric asthma outcomes in primary health care: a randomised controlled trial.
        Med J Aust. 2011; 195: 405-409
        • Holton C.
        • Crockett A.
        • Nelson M.
        • et al.
        Does spirometry training in general practice improve quality and outcomes of asthma care?.
        Int J Qual Health Care. 2011; 23: 545-553
        • Basihnab E.
        • Karner C.
        Primary care based clinics for asthma.
        Cochrane Cochrane Database Syst Rev. 2012; 4: CD003533
        • Østbye T.
        • Yarnall K.S.
        • Krause K.M.
        • Pollak K.I.
        • Gradison M.
        • Michener J.L.
        Is there time for management of patients with chronic diseases in primary care?.
        Ann Fam Med. 2005; 3: 209-214
        • Cloutier M.M.
        • Tennen H.
        • Wakefield D.B.
        • Brazil K.
        • Hall C.B.
        Improving clinician self-efficacy does not increase asthma guideline use by primary care clinicians.
        Acad Pediatr. 2012; 12: 312-318
        • Ryan D.
        • Price D.
        • Musgrave S.D.
        • et al.
        Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomized controlled trial.
        BMJ. 2012; 344: e1756
        • Yawn B.P.
        • Bertram S.
        • Kurland M.
        • et al.
        Protocol for the asthma tools study: a pragmatic practice-based research network trial.
        Pragmat Obs Res. 2013; 4: 7-18
        • Juniper E.F.
        • Buist A.S.
        • Cox F.M.
        • Ferrie P.J.
        • King D.R.
        Validation of a standardized version of the Asthma Quality of Life Questionnaire.
        Chest. 1999; 115: 1265-1270
        • Liu A.H.
        • Zeiger R.
        • Sorkness C.
        • et al.
        Development and cross-sectional validation of the Childhood Asthma Control Test.
        J Allergy Clin Immunol. 2007; 119: 817-825
        • Juniper E.F.
        • Guyatt G.H.
        • Feeny D.H.
        • Ferrie P.J.
        • Griffith L.E.
        • Townsend M.
        Measuring quality of life in children with asthma.
        Qual Life Res. 1996; 5: 35-46
        • Boulet L.P.
        • Vervloet D.
        • Magar Y.
        • Foster J.M.
        Adherence: the goal to control asthma.
        Clin Chest Med. 2012; 33: 405-417
        • Jentzsch N.S.
        • Camargos P.
        • Sarinho E.S.
        • Bousquet J.
        Adherence rate to beclomethasone dipropionate and the level of asthma control.
        Respir Med. 2012; 106: 338-343
        • Al-Jahdali H.
        • Ahmed A.
        • Al-Harbi A.
        • et al.
        Improper inhaler technique is associated with poor asthma control and frequent emergency department visits.
        Allergy Asthma Clin Immunol. 2013; 9: 8
        • Morgan W.J.
        • Crain E.F.
        • Gruchalla R.S.
        • et al.
        Results of a home-based environmental intervention among urban children with asthma.
        N Engl J Med. 2004; 351: 1068-1080
        • Korn S.
        • Both J.
        • Jung M.
        • Hübner M.
        • Taube C.
        • Buhl R.
        Prospective evaluation of current asthma control using ACQ and ACT compared with GINA criteria.
        Ann Allergy Asthma Immunol. 2011; 107: 474-479
        • Alpaydin A.O.
        • Bora M.
        • Yorgancioglu A.
        • Coskun A.S.
        • Celik P.
        Asthma control test and asthma quality of life questionnaire association in adults.
        Iran J Allergy Asthma Immunol. 2012; 11: 301-307
        • Jia C.E.
        • Zhang H.P.
        • Lv Y.
        • et al.
        The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: systematic review and meta-analysis.
        J Allergy Clin Immunol. 2013; 131: 695-703
        • Cabana M.D.
        • Slish K.K.
        • Nan B.
        • Lin X.
        • Clark N.M.
        Asking the correct questions to assess asthma symptoms.
        Clin Pediatr (Phila). 2005; 44: 319-325