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Asthma Control Questionnaire

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Elizabeth F Juniper – 1st expert on this subject based on the ideXlab platform

  • from the authors the Asthma Control Questionnaire for children still more questions than answers
    European Respiratory Journal, 2011
    Co-Authors: Elizabeth F Juniper, Kevin Gruffyddjones, Sabbi Ward, Klas Svensson


    From the authors:

    L. van den Bemt and co-workers raise an important issue concerning the use of both self- and interviewer-administered versions for the validation of the Asthma Control Questionnaire (ACQ) in children and one we considered carefully when designing the study. We wanted to ensure that the ACQ could be used in clinical practice (individual children followed over time), paediatric research (6–16 yrs) and adult research (≥12 yrs). Therefore, two separate Questionnaires was not an option. The development of the ACQ had ensured that it contained the questions that are important for assessing Asthma Control in children 6–16 yrs of age (content validity) but we knew the self-administered adult version could not be completed unaided by younger children. We considered validating an interviewer version for all ages (6–16 yrs) but realised this would be less practical for older children and also for adult clinical trials that enrol patients ≥12 yrs of age. The decision to develop …

  • Asthma Control Questionnaire in children validation measurement properties interpretation
    European Respiratory Journal, 2010
    Co-Authors: Elizabeth F Juniper, Kevin Gruffyddjones, Sabbi Ward, Klas Svensson


    The Asthma Control Questionnaire (ACQ) has been validated in adults to measure the primary goal of management (minimisation of symptoms, activity limitations, short-acting β2-agonist use and airway narrowing). The present study evaluated the validity, measurement properties and interpretability of the ACQ in children aged 6–16 yrs.

    35 children attended clinic on three occasions (0, 1 and 4 weeks) and completed the ACQ, Mini Paediatric Asthma Quality of Life Questionnaire and the Royal College of Physicians’ “Three Questions”. Parents completed the Paediatric Asthma Caregiver’s Quality of Life Questionnaire. Between visits, children completed the Asthma Control Diary and measured peak expiratory flow. At weeks 1 and 4, clinicians and parents completed Global Rating of Change Questionnaires.

    All patients completed the study. 19 children were stable between two assessments and provided evidence of good test–retest reliability (intraclass correlation coefficient 0.79). The ACQ was responsive to change in Asthma Control (p = 0.026) and the mean±sd Minimal Important Difference was 0.52±0.45. Both cross-sectional and longitudinal correlations between the ACQ and the other outcomes were close to predicted and provided evidence that the ACQ measures Asthma Control in children.

    The ACQ has strong measurement properties and is valid for use in children aged 6–16 yrs. In children aged 6–10 yrs, it must be administered by a trained interviewer.

  • identifying well Controlled and not well Controlled Asthma using the Asthma Control Questionnaire
    Respiratory Medicine, 2006
    Co-Authors: Elizabeth F Juniper, Jean Bousquet, Linda Abetz, Eric D Bateman


    Summary The 7-item Asthma Control Questionnaire (ACQ) has been validated to measure the goals of Asthma management as defined by international guidelines (minimisation of day- and night-time symptoms, activity limitation, β 2 -agonist use and bronchoconstriction). Responses are given on a 7-point scale and the overall score is the mean of the responses (0=totally Controlled, 6=severely unControlled). The aim of this analysis was to determine the cut-point on the ACQ that best differentiates between ‘well-Controlled’ and ‘not well-Controlled’ for (a) clinical practice (low risk of missing ‘not well-Controlled’) and (b) clinical trials (low risk of including ‘well-Controlled’). All 1323 patients who provided data sets at week 12 in the Gaining Optimal Asthma Control (GOAL) clinical trial were included in the analysis. The gold standard for ‘well-Controlled’ was a composite based on the GINA/NIH guidelines and derived from data collected in the clinical trial diaries and clinic records. The analysis showed that the crossover point between ‘well-Controlled’ and ‘not well-Controlled’ is close to 1.00 on the ACQ. However, to be confident that a patient has well-Controlled Asthma, the optimal cut-point is 0.75 (negative predictive value=0.85). To be confident that the patient has inadequately Controlled Asthma, the optimal cut-point is 1.50 (positive predictive value=0.88). In conclusion, knowledge of these cut-points will enhance practising clinicians ability to identify patients whose Asthma requires additional treatment, enable investigators to enroll poorly Controlled patients into studies and for both clinicians and investigators to evaluate whether treatment goals are being achieved.

Parameswaran Nair – 2nd expert on this subject based on the ideXlab platform

  • weight adjusted intravenous reslizumab in severe Asthma with inadequate response to fixed dose subcutaneous mepolizumab
    American Journal of Respiratory and Critical Care Medicine, 2018
    Co-Authors: Manali Mukherjee, Fernando Aleman Paramo, Melanie Kjarsgaard, Brittany M Salter, Gayatri Nair, Nicola Lavigne, Katherine Radford, Roma Sehmi, Parameswaran Nair


    Rationale: Clinical benefits of fixed-dose 100-mg subcutaneous (SC) mepolizumab in prednisone-dependent patients are modest when sputum eosinophilia is not adequately Controlled.Objectives: This study compared treatment response of weight-adjusted intravenous (IV) reslizumab in patients previously treated with 100-mg SC mepolizumab.Methods: Ten prednisone-dependent patients with Asthma (sputum eosinophils >3% and blood eosinophils >300 cells/μl), who had previously received mepolizumab (100 mg SC dosed every 4 wk [Q4W]) for at least 1 year, received two infusions of placebo (Q4W) followed by four infusions of 3.0 mg/kg reslizumab Q4W in a single-blind, placebo-Controlled sequential trial. Primary outcomes were reduction of eosinophils in sputum and blood. Additional outcomes included FEV1, Asthma Control Questionnaire, eosinophil peroxidase, IL-5, sputum and blood innate lymphoid cells group 2, eosinophil progenitor cells, and autoimmune responses.Measurements and Main Results: IV reslizumab attenuated sp…

  • reslizumab for poorly Controlled eosinophilic Asthma a randomized placebo Controlled study
    American Journal of Respiratory and Critical Care Medicine, 2011
    Co-Authors: Mario Castro, Sameer K. Mathur, Frederick E. Hargreave, Louis-philippe Boulet, James B Young, Jeffrey H Wilkins, Timothy Henkel, Parameswaran Nair


    Rationale: Eosinophilic Asthma is a phenotype of Asthma characterized by the persistence of eosinophils in the airways. IL-5 is involved in the activation and survival of eosinophils.Objectives: To evaluate the effect of the antibody to IL-5, reslizumab, in patients with eosinophilic Asthma that is poorly Controlled with high-dose inhaled corticosteroid.Methods: Patients were randomly assigned to receive infusions of reslizumab at 3.0 mg/kg (n = 53) or placebo (n = 53) at baseline and at Weeks 4, 8, and 12, with stratification by baseline Asthma Control Questionnaire (ACQ) score less than or equal to 2 or greater than 2. The primary efficacy measure was the difference between the reslizumab and placebo groups in the change in ACQ score from baseline to end of therapy (Week 15 or early withdrawal).Measurements and Main Results: Mean changes from baseline to end of therapy in ACQ score were –0.7 in the reslizumab group and –0.3 in the placebo group (P = 0.054) and in FEV1 were 0.18 and –0.08 L, respectively…

Eric D Bateman – 3rd expert on this subject based on the ideXlab platform

  • Erratum: International ERS/ATS guidelines on definition, evaluation and treatment of severe Asthma (European Respiratory Journal (2014) 43 (343–373) DOI: 10.1183/09031936.00202013)
    European Respiratory Journal, 2020
    Co-Authors: Kian Fan Chung, Mario Castro, Sally E Wenzel, Eric D Bateman, Jan Brozek, Andrew Bush, Peter J. Sterk, Ian M. Adcock, Eugene R. Bleecker


    This article from the February 2014 issue of the European Respiratory Journal was originally published with errors in the criteria used to define severe Asthma on page 350 and in table 3. At both aforementioned points in the article, the “poor symptom Control” criterion for severe Asthma should have been defined as: Asthma Control Questionnaire (ACQ) consistently 1.5 or Asthma Control Test (ACT) 1.5 or ACT 3 days each) in the previous year.

  • A randomized study of BI 671800, a CRTH2 antagonist, as add-on therapy in poorly Controlled Asthma.
    Allergy and Asthma Proceedings, 2017
    Co-Authors: David Miller, Eric D Bateman, Chester C. Wood, Craig Laforce, Jon Blatchford, James Hilbert, Abhya Gupta, Andrew Fowler


    BACKGROUND: Asthma is characterized by a complex interaction of inflammatory mediators. The prostaglandin D2 receptor, chemoattractant receptor-homologous molecule on Th2 cells (CRTH2), plays a pivotal role in the pathogenesis of allergic airway inflammation. OBJECTIVE: To ealuate the efficacy, safety, and pharmacokinetics of BI 671800, a CRTH2 antagonist, when added to inhaled corticosteroid therapy in adult patients with symptomatic Asthma. METHODS: In this phase IIa, 12-week, randomized, double-blind, three-period, four-treatment, incomplete block crossover trial, BI 671800 was administered either as a single 400-mg dose in the morning (A.M.) or evening (P.M.), or 200 mg twice daily (A.M. and P.M.) versus placebo, together with fluticasone propionate (44 μg, two inhalations twice daily). The primary end point was the change from baseline in trough forced expiratory volume in 1 second percentage predicted after 4 weeks. The secondary end point was the change in Asthma Control Questionnaire score from baseline. RESULTS: A total of 108 patients were randomized and treated. After 4 weeks, the adjusted mean (± SE) treatment differences for the primary end point versus placebo were 0.08 ± 0.62%, 0.28 ± 0.61%, and 0.67 ± 0.63% for BI 671800 at 200 mg twice daily, 400 mg A.M., and 400 mg P.M., respectively (not statistically significant). No statistically significant or clinically meaningful differences in the Asthma Control Questionnaire score were observed versus placebo. Each treatment was well tolerated. CONCLUSION: BI 671800 at a dose of 400 mg administered for 4 weeks with fluticasone propionate did not provide clinical improvement in patients with Asthma; reasons for this are unclear, but it may be due to insufficient inhibition of the CRTH2 receptor at the doses used.

  • magnitude of effect of Asthma treatments on Asthma quality of life Questionnaire and Asthma Control Questionnaire scores systematic review and network meta analysis
    The Journal of Allergy and Clinical Immunology, 2015
    Co-Authors: Eric D Bateman, Dirk Esser, Costel Chirila, Maria Fernandez, Andy Fowler, Petra Moronizentgraf, Mark J Fitzgerald


    Background The Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire (ACQ) are widely used in Asthma research; however, in studies of newer Asthma treatments, mean improvements in these measures compared with placebo arms do not exceed the minimal important difference (MID), particularly when a new treatment is added to current treatment. Objective We performed a systematic review and network meta-analysis to examine the magnitude of AQLQ and ACQ responses achieved with commonly used Asthma drugs and factors influencing these end points in clinical trials. Methods A systematic literature search was conducted to identify blinded randomized Controlled trials reporting AQLQ or ACQ results. Mixed treatment comparisons, combined with meta-regression, were then performed. Results Of the 64 randomized Controlled trials (42,527 patients) identified, 54 included the AQLQ and 11 included the ACQ as end points. The presence of a run-in period, the nature of treatment during the run-in period, concurrent treatment during the treatment period, and instrument version significantly influenced the change in AQLQ score from baseline and whether it exceeded the MID. When compared with placebo, only inhaled corticosteroids (ICSs), with or without a long-acting β-agonist, achieved the MID. The ACQ results were comparable with those of the AQLQ: no differences from placebo exceeded the MID, and ICS-based treatments provided the greatest improvements. Conclusion The established within-patient MID for the ACQ and AQLQ is not achievable as a group-wise efficacy threshold between treatment arms in clinical studies in which Controllers are added to ICS treatment. Thus in addition to reporting mean changes of the instruments, other measurement criteria should be considered, including responder analyses.