Chest

Chest

Volume 129, Issue 4, April 2006, Pages 925-932
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Original Research
Brief Questionnaires for Patient-Reported Outcomes in Asthma: Validation and Usefulness in a Primary Care Setting

https://doi.org/10.1378/chest.129.4.925Get rights and content

Study objectives and design

Health-related quality of life (QoL) instruments are generally used for studies of asthma in specialized settings. For primary care use, there is a need for brief and simple questionnaires for structured patient-reported outcomes. We validated the Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ), using the Asthma Quality of Life Questionnaire with standardized activities (AQLQ[S]) as the “gold standard.” The Asthma Control Questionnaire (ACQ) was validated against the symptoms domain of the AQLQ(S). Patients were characterized by the Short Form-36 Health Survey (SF-36).

Subjects

One hundred eight patients (68 women) with asthma diagnosed by their physicians from 24 primary care centers completed two visits (2 to 3 months apart). Their mean SF-36 scores were lower than the national norm for all domains.

Results

The Mini-AQLQ and ACQ correlated well with the AQLQ(S). Reliability, determined in 57 patients with stable AQLQ(S) scores, was good. Both brief questionnaires detected improvement or deterioration of patients at the group level. Global ratings of disease severity by patients or clinicians correlated poorly with disease-specific QoL scores.

Conclusions

The Mini-AQLQ and ACQ instruments are sufficiently simple and robust to be suitable for research and quality of care monitoring in primary care at the group level. They may, after further validation, even be useful in the management of individual patients.

Section snippets

Methods and Materials

A prospective, multicenter study was performed in 24 primary health-care centers in the city and suburbs of Stockholm. The study centers were evenly distributed throughout the county and were selected to ensure inclusion of patients with different socioeconomic backgrounds. Their physicians and nurses had limited or no experience of research routines. Furthermore, the inclusion criteria were wide. The study was approved by the Ethics Committee of the Karolinska Institute, Stockholm, Sweden.

Results

According to the GINA classification,5 76 patients had severe asthma, 21 had moderate asthma, 8 had mild asthma, and 2 had intermittent asthma. Severity could not be determined in one patient due to missing data (Table 1). There was no significant correlation (r < 0.169; p = 0.169, n = 68) between AQLQ(S) scores and pulmonary function measured as FEV1 percentage of predicted.

The patients scored lower than the national norm in all domains of the SF-36, despite ongoing treatment. This impairment

Discussion

The brief questionnaires for patient-reported outcomes evaluated in this study had good measurement properties in an ordinary Swedish primary care setting. Results obtained with the Mini-AQLQ and our “gold standard,” the AQLQ(S), correlated well, and the ACQ correlated well with the overall and symptoms domain scores of the AQLQ(S). The questionnaires appeared to be equally responsive, but this was not tested with a structured intervention. Our results show that the brief instruments can

ACKNOWLEDGMENT

The authors thank research nurse Lena Wahlberg for monitoring of the study sites and for entering results into the database. The enthusiasm and willingness to cooperate among the physicians and nurses of the participating health care centers are much appreciated.

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    • Cited by (0)

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    This study was supported by the Vårdal Foundation, the Karolinska Institute, the Stockholm County, and the Drug and Therapeutics Committees of the Stockholm and Sörmland Counties.

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    Copyright © 2006 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.