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Original Research: ASTHMA |

The Relationship of Asthma Impairment Determined by Psychometric Tools to Future Asthma ExacerbationsRelationship of Asthma Impairment to Risk

Michael Schatz, MD, FCCP; Robert S. Zeiger, MD, PhD; Su-Jau Yang, PhD; Wansu Chen, MS; William Crawford, MD; Shiva Sajjan, PhD; Felicia Allen-Ramey, PhD; Fuhlbrigge AL; for the Childhood Asthma Management Program Research Group
Author and Funding Information

From the Department of Allergy (Drs Schatz, Zeiger, and Crawford), and the Department of Research and Evaluation (Dr Yang and Ms Chen), Kaiser Permanente Medical Center, San Diego and Los Angeles, CA; and the Department of Global Health Outcomes (Drs Sajjan and Allen-Ramey), Merck & Co, Inc, West Point, PA.

Correspondence to: Michael Schatz, MD, FCCP, Department of Allergy, Kaiser-Permanente Medical Center, 7060 Clairemont Mesa Blvd, San Diego, CA 92111; e-mail: michael.x.schatz@kp.org


Funding/Support: This study was funded by a research grant from Merck & Co, Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(1):66-72. doi:10.1378/chest.11-0574
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Published online

Background:  Impairment and risk are considered separate domains of asthma control, but relationships between them are not completely understood. We compared three validated questionnaires reflecting asthma impairment in their ability to predict future exacerbations.

Methods:  Two thousand six hundred eighty patients with persistent asthma completed a survey that included the Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (mAQLQ), and Asthma Impact Survey (AIS-6), as well as a history of exacerbations in the prior 12 months. An exploratory factor analysis was performed using the questions of the three tools, and individual patient factor scores were calculated. Independent relationships between predictors (tools and factors) and exacerbations the following year captured from administrative data were evaluated.

Results:  Each tool was significantly related (P < .0001) to future exacerbations above and beyond the risk conferred by prior exacerbations (relative risk [RR] = 1.3). When prior exacerbations were included in the model, the three impairment tools provided similar and overlapping information, such that only the mAQLQ entered the model (RR = 1.3; 95% CI, 1.1-1.5). Factor analysis revealed three factors (symptoms, activity, and bother) that were each significantly associated (P < .0001) with future asthma exacerbations. However, only the activity factor was independently related to future exacerbations.

Conclusions:  Asthma impairment is significantly related to the risk of future exacerbations, but the ACT, mAQLQ, and AIS-6 do not provide independent information from each other in this regard. Interference with activities is the primary subjective component of asthma impairment that is related to the risk of future exacerbations.


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