Murphy Kevin R, Chipps Bradley, Beuther David A, Wise Robert A, McCann William, Gilbert Ileen, Eudicone James M, Gandhi Hitesh N, Harding Gale, Coyne Karin S, Zeiger Robert S
Boys Town National Research Hospital, Boys Town, Neb.
Capital Allergy & Respiratory Disease Center, Sacramento, Calif.
J Allergy Clin Immunol Pract. 2020 Jul-Aug;8(7):2263-2274.e5. doi: 10.1016/j.jaip.2020.02.042. Epub 2020 May 6.
Asthma exacerbation risk increases with worsening asthma control. Prevailing numerical control tools evaluate only current symptom impairment despite the importance of also assessing risk based on exacerbation history. An easy-to-use questionnaire addressing impairment and risk domains of control is needed.
To validate a composite asthma control tool that includes impairment and risk assessments (Asthma Impairment and Risk Questionnaire [AIRQ]).
Four-hundred forty-two patients aged ≥12 years with physician-diagnosed asthma who were followed in specialty practices completed 15 impairment and risk questions with dichotomized yes/no responses. Patients spanned all Global Initiative for Asthma severities and were classified as well-controlled, not well-controlled, or very poorly controlled according to a standard of Asthma Control Test (ACT) score plus prior-year exacerbations. Logistic regression analyses identified questions with the greatest predictive validity to discriminate among patients and determine cut points for these 3 classifications.
The final AIRQ comprises 10 equally weighted yes/no impairment and risk questions. The final 10-item models yielded receiver operating characteristic curves of 0.94 to identify well-controlled versus not well-/very poorly controlled and 0.93 to identify well-/not well-controlled versus very poorly controlled asthma, as reflected by the ACT plus prior-year exacerbations standard. Cut points of 0-1, 2-4, and 5-10 best represented well-, not well-, and very poorly controlled asthma.
AIRQ is a rigorously validated composite measure designed to identify adults and adolescents with varying degrees of asthma control. Ongoing investigations will determine test-retest reliability, responsiveness to change, and predictive ability for future exacerbations.
哮喘控制情况恶化时，哮喘急性加重的风险会增加。尽管基于急性加重病史评估风险很重要，但现有的数值控制工具仅评估当前症状损害情况。因此，需要一种易于使用的问卷来评估控制的损害和风险领域。
验证一种包含损害和风险评估的综合哮喘控制工具（哮喘损害与风险问卷 [AIRQ]）。
442名年龄≥12岁、经医生诊断为哮喘且在专科诊所接受随访的患者完成了15个关于损害和风险的问题，回答为是/否的二分法形式。患者涵盖了全球哮喘防治创议（Global Initiative for Asthma）定义的所有严重程度，并根据哮喘控制测试（ACT）评分加上前一年的急性加重情况分为控制良好、控制不佳或控制极差。逻辑回归分析确定了对区分患者具有最大预测效度的问题，并确定这三种分类的切点。
最终的AIRQ包括10个权重相等的是/否损害和风险问题。最终的10项模型得出的受试者工作特征曲线在以ACT加上前一年急性加重情况为标准时，区分控制良好与控制不佳/极差的曲线下面积为0.94，区分控制良好/不佳与控制极差的哮喘的曲线下面积为0.93。0 - 1、2 - 4和5 - 10的切点分别最能代表控制良好、控制不佳和控制极差的哮喘。
AIRQ是一种经过严格验证的综合测量工具，旨在识别不同程度哮喘控制情况的成人和青少年。正在进行的研究将确定其重测信度、对变化的反应性以及对未来急性加重的预测能力。
