Asthma outcomes: Composite scores of asthma control

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Background

Current asthma guidelines recommend assessing the level of a patient’s asthma control. Consequently, there is increasing use of asthma control as an outcome measure in clinical research studies. Several composite assessment instruments have been developed to measure asthma control.

Objective

National Institutes of Health institutes and federal agencies convened an expert group to propose the most appropriate standardized composite score of asthma control instruments to be used in future asthma studies.

Methods

We conducted a comprehensive search of PubMed using both the National Library of Medicine’s Medical Subject Headings and key terms to identify studies that attempted to develop and/or test composite score instruments for asthma control. We classified instruments as core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at a National Institutes of Health–organized workshop convened in March 2010 and finalized in September 2011.

Results

We identified 17 composite score instruments with published validation information; all had comparable content. Eight instruments demonstrated responsiveness over time; 3 demonstrated responsiveness to treatment. A minimal clinically important difference has been established for 3 instruments. The instruments have demographic limitations; some are proprietary, and their use could be limited by cost.

Conclusion

Two asthma composite score instruments are sufficiently validated for use in adult populations, but additional research is necessary to validate their use in nonwhite populations. Gaps also exist in validating instruments for pediatric populations.

Section snippets

Definitions and methodology for measurement

The ATS/ERS statement divided its “Composite Measures of Asthma Control” section into composite measures expressed as (1) categorical variables in which a descriptive category of asthma control is measured (eg, asthma control days/asthma-free days/episode-free days, “well-controlled” asthma weeks/“total control” weeks, or guideline-based categories, including “well controlled,” “not well controlled,” or “poorly controlled” asthma) and (2) numeric variables in which several independent variables

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  • Cited by (0)

    The Asthma Outcomes workshop was funded by contributions from the National Institute of Allergy and Infectious Diseases; the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Institute of Environmental Health Sciences; the Agency for Healthcare Research and Quality; and the Merck Childhood Asthma Network, as well as by a grant from the Robert Wood Johnson Foundation. Contributions from the National Heart, Lung, and Blood Institute; the National Institute of Allergy and Infectious Diseases; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Institute of Environmental Health Sciences, and the US Environmental Protection Agency funded the publication of this article and all other articles in this supplement.

    Disclosure of potential conflict of interest: M. Schatz has consulted for Amgen and has received research support from Aerocrine, GlaxoSmithKline, Merck, and Genentech. M. Castro has received consulting and speaker fees from Asthmatx; is a speaker and is on the advisory board for Genentech; is a speaker for AstraZeneca, Merck, and GlaxoSmithKline; has received royalties from Elsevier; and has received research support from Asthmatx, Amgen, Ception/Cephalon, Genentech, MedImmune, Merck, Novartis, the NIH, and GlaxoSmithKline. J. R. Sheller has received research support from Actelion Pharmaceuticals. S. W. Stoloff is Chairman of the Allergy and Asthma Network Mothers of Asthmatics Board. The rest of the authors declare that they have no relevant conflicts of interest.

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