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Asthma Control

Section Leader: Peter Gibson, MBBS

WHAT IS ASTHMA CONTROL AND WHY IS IT IMPORTANT?

Asthma control has emerged as a key concept that is now seen as having major practical importance in the assessment and management of people with asthma. Increasingly, clinical management guidelines are recommending that asthma care be based around the assessment of control, and that these assessments be used to modify treatment.

Asthma control is about how the disease affects patients and is a clinical assessment. Some descriptions and links to guidelines that now use control are given below:

“Control” refers to a spectrum of clinical characteristics which describe the extent to which the manifestations of asthma have been reduced or removed by treatment. Selected biomarkers may provide additional information about the extent to which future risk to the patient has been minimized. Asthma control is of key importance to the patient. [1]

From the GINA guidelines:

ASTHMA CONTROL
Asthma control refers to control of the clinical manifestations of disease. A working scheme based on current opinion that has not been validated provides the
characteristics of controlled, partly controlled and uncontrolled asthma. Complete control of asthma is commonly achieved with treatment, the aim of which
should be to achieve and maintain control for prolonged periods, with due regard to the safety of treatment, potential for adverse effects, and the cost of treatment
required to achieve this goal. [2]

References/links:

Definition and discussion of asthma control:

[1] Helen K Reddel and D Robin Taylor,
on behalf of members of the Task Force on Asthma Control and Exacerbations*
Asthma severity and asthma control: which is which?
Journal , in press

[2] GINA guidelines and asthma control: www.ginasthma.org

HOW IS ASTHMA CONTROL ASSESSED?

Asthma control can be assessed by several means:

  1. Clinical interview: http://www.ginasthma.org GINA guidelines table 4.3.1
  2. Questionnaires for adults:

    1. Juniper asthma control questionnaire(ACQ): Juniper, E. F.,  O'Byrne, P. M. and Guyatt, G. H. (1999) Development and validation of a questionnaire to measure asthma control. Eur Resp J 14 , pp. 902-907 Juniper, E. F.,  Svennson, K.,  Mork, A-C and Stahl, E. (2005) Measurement properties and interpretation of three shortened versions of the asthma control questionnaire. Resp Med 99, pp. 553-558
      http://www.qoltech.co.uk
    2. Asthma therapy assessment questionnaire (ATAQ): Vollmer, W. M. (2004) Assessment of asthma control and severity. Ann Allergy Asthma Immunol 93, pp. 409-414.
      http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=
      ShowDetailView&TermToSearch=15562878&ordinalpos=1&itool=
      EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
    3. Association of Asthma Control with Health Care Utilization and Quality of Life: Vollmer, W. M. (1999)
    4. Association of Asthma Control with Health Care Utilization - A Prospective Evaluation: Vollmer, W. M. (2002)
    5. Asthma control test (ACT): Nathan, R. A.,  Sorkness, C. A. and Kosinski, M. (2004) Development of the Asthma Control Test: A survey for assessing asthma control. J Allergy Clin Immunol 113 , pp. 59-65.
      http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd
      =ShowDetailView&TermToSearch =14713908&ordinalpos=2&itool=
      EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
    6. Asthma control scoring system (ACSS): LeBlanc A, Robichaud P, Lacasse Y, Boulet LP. Quantification of asthma control: validation of the Asthma Control Scoring System. Allergy. 2007 Feb;62(2):120-5.
      http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd
      =ShowDetailView&TermToSearch=17298419&ordinalpos= 14&itool=
      EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
  3. Questionnaires for children:

    1. Asthma quiz for kids: FM Ducharme, GM Davis, F Noya, H Rich, P Ernst. TheAsthma Quiz for Kidz: A validated tool to appreciate the level of asthma control in children. Can Respir J 2004;11(8):541-546.
      http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=
      ShowDetailView&TermToSearch=15611802&ordinalpos =3&itool=
      EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
    2. Asthma control test for children: Liu AH, Zeiger R, Sorkness C, Mahr T, Ostrom N, Burgess S, Rosenzweig JC, Manjunath R. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol. 2007 Apr;119(4):817-25. Epub 2007 Mar 13.
      http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=
      ShowDetailView&TermToSearch=17353040&ordinalpos= 9&itool=
      EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
    3. Asthma therapy assessment questionnaire(ATAQ) Elizabeth A. Skinner, Gregory B. Diette, Pamela J. Algatt-Bergstrom, Theresa T.H. Nguyen, Rebecca D. Clark, Leona E. Markson, Albert W. Wu. Disease Management. 2004, 7(4): 305-313. doi:10.1089/dis.2004.7.305. http://www.liebertonline.com/doi/abs/10.1089%2Fdis.2004.7.30

HOW DO YOU USE THE ASSESSMENT IN CLINICAL CARE ?

SEE: www.ginasthma.org