Measurement of asthma control according to Global Initiative for Asthma guidelines: a comparison with the Asthma Control Questionnaire

José María Olaguibel, Santiago Quirce, Berta Juliá, Cristina Fernández, Ana María Fortuna, Jesús Molina, Vicente Plaza, MAGIC Study Group, María Aguar, Ramón Agüero, Dolores Aicart, Teresa Almela, Carlos Almonacid, Alicia Alonso, Francisco Álvarez, Julio Álvarez, María Álvarez, Pedro Álvarez, Javier Amiama, Ignacio Antepara, Margarita Armisen, Aurelio Arnedillo, Mikel Azpiazu, Javier Barrio, Teresa Bazús, Dolores Bello, Miguel Bentabol, Ana Beristain, Carlos Blanco, Rosa Blanco, Luís Borderías, Ana Bustamante, Pedro Caballero, Pedro Cabrera, Francisco Calero, Eduardo Calvo, Gabriela Cantó, Concepción Cañete, Francisco Carballada, Remedios Cárdenas, Manuel Carpintero, Pedro Carretero, Teresa Carrillo, María Casado, Francisco Casas, Pilar Cebollero, Carolina Cisneros, Lourdes Clemente, Carlos Colas, José Compaired, Luis Compte, Concepción Cordobés, Ignacio Dávila, Alfredo De Diego, Eva De Higes, Belén De la Hoz, Juan De León, Ángel Del Moral, Julio Delgado, Carmen Díaz, Carlos Diego, Carmen Domínguez, Javier Domínguez, Leopoldo Domínguez, Luisma Entrenas, Miguel Escobar, Manuel Espigares, María Espinosa, Rubén Félix, Francisco Feo, Araceli Fernández, Consuelo Fernández, Eduardo Fernández, Francisco Fernández, Mar Fernández, Javier Figueroa, Xavier Flor, Jesús García, Jose García, Juan García, Marimar García, Rosa García, García-Cosío, García-Salmones, Elisa Gómez, David González, Francisco González, Ruperto González, Valentina Gutiérrez, Aythamy Henriquez, Alicia Hernández, Dolores Hernández, Elena Hernández, Francisco Hernández, Eduardo Hidalgo, Paloma Ibañez, Fernando Iglesias, Javier Iglesias, José Ignacio, María Irizar, José Izquierdo, Jesús Jiménez, Gemma Jorro, Natividad Labarta, Maite Lamban, Armando Larnia, Monserrat León, Alberto Levy, Antolín López, Gonzalo Lumbreras, Tamin Malek, Carmen Marcos, Juanjo Martín, Agustín Martínez, Carlos Martínez, Dara Martínez, Eva Martínez, José Martínez, Montse Mas, Juan Medina, Carlos Melero, Jorge Méndez, Ascensión Minguez, Isabel Molero, Alvaro Moreno, Carmen Moreno, Juan Moreno, Javier Muñoz, Rosa Muñoz, Pilar Mur, Ana Navarro, José Navarro, José Negro, Antonio Nieto, María Nualart, Alberto Oheling, Pedro Ojeda, Alicia Padilla, Antonio Parra, María Pedrosa, María Peiron, Antonio Peláez, Pedro Penela, José Peñas, Antonio Pereira, Pérez de Llano, Alvaro Pérez, Gerardo Pérez, Jacinto Ramos, Marisa Rivera, Teresa Robledo, César Rodríguez, Fernando Rodríguez, Gema Rodríguez, Pablo Rodríguez, Manuela Rubio, Alejandro Sánchez, Anselmo Sánchez, Inmaculada Sánchez, José Sánchez, Inmaculada Sánchez-Guerrero, Carlos Senent, Juan Serra, José Serrano, Pere Simonet, José Soto, Javier Subiza, Ana Tabar, Rosario Timiraos, Cristóbal Trillo, Isabel Urrutia, Luis Valdés, Joan Valldeperas, Rosario Vargas, Arancha Vega, José Vega, Héctor Verea, Juan Vicente, Carmen Vidal, Laura Vigil, Concepción Vila, Rosa Villafàfila, Carlos Villasante, José Zubeldia, José María Olaguibel, Santiago Quirce, Berta Juliá, Cristina Fernández, Ana María Fortuna, Jesús Molina, Vicente Plaza, MAGIC Study Group, María Aguar, Ramón Agüero, Dolores Aicart, Teresa Almela, Carlos Almonacid, Alicia Alonso, Francisco Álvarez, Julio Álvarez, María Álvarez, Pedro Álvarez, Javier Amiama, Ignacio Antepara, Margarita Armisen, Aurelio Arnedillo, Mikel Azpiazu, Javier Barrio, Teresa Bazús, Dolores Bello, Miguel Bentabol, Ana Beristain, Carlos Blanco, Rosa Blanco, Luís Borderías, Ana Bustamante, Pedro Caballero, Pedro Cabrera, Francisco Calero, Eduardo Calvo, Gabriela Cantó, Concepción Cañete, Francisco Carballada, Remedios Cárdenas, Manuel Carpintero, Pedro Carretero, Teresa Carrillo, María Casado, Francisco Casas, Pilar Cebollero, Carolina Cisneros, Lourdes Clemente, Carlos Colas, José Compaired, Luis Compte, Concepción Cordobés, Ignacio Dávila, Alfredo De Diego, Eva De Higes, Belén De la Hoz, Juan De León, Ángel Del Moral, Julio Delgado, Carmen Díaz, Carlos Diego, Carmen Domínguez, Javier Domínguez, Leopoldo Domínguez, Luisma Entrenas, Miguel Escobar, Manuel Espigares, María Espinosa, Rubén Félix, Francisco Feo, Araceli Fernández, Consuelo Fernández, Eduardo Fernández, Francisco Fernández, Mar Fernández, Javier Figueroa, Xavier Flor, Jesús García, Jose García, Juan García, Marimar García, Rosa García, García-Cosío, García-Salmones, Elisa Gómez, David González, Francisco González, Ruperto González, Valentina Gutiérrez, Aythamy Henriquez, Alicia Hernández, Dolores Hernández, Elena Hernández, Francisco Hernández, Eduardo Hidalgo, Paloma Ibañez, Fernando Iglesias, Javier Iglesias, José Ignacio, María Irizar, José Izquierdo, Jesús Jiménez, Gemma Jorro, Natividad Labarta, Maite Lamban, Armando Larnia, Monserrat León, Alberto Levy, Antolín López, Gonzalo Lumbreras, Tamin Malek, Carmen Marcos, Juanjo Martín, Agustín Martínez, Carlos Martínez, Dara Martínez, Eva Martínez, José Martínez, Montse Mas, Juan Medina, Carlos Melero, Jorge Méndez, Ascensión Minguez, Isabel Molero, Alvaro Moreno, Carmen Moreno, Juan Moreno, Javier Muñoz, Rosa Muñoz, Pilar Mur, Ana Navarro, José Navarro, José Negro, Antonio Nieto, María Nualart, Alberto Oheling, Pedro Ojeda, Alicia Padilla, Antonio Parra, María Pedrosa, María Peiron, Antonio Peláez, Pedro Penela, José Peñas, Antonio Pereira, Pérez de Llano, Alvaro Pérez, Gerardo Pérez, Jacinto Ramos, Marisa Rivera, Teresa Robledo, César Rodríguez, Fernando Rodríguez, Gema Rodríguez, Pablo Rodríguez, Manuela Rubio, Alejandro Sánchez, Anselmo Sánchez, Inmaculada Sánchez, José Sánchez, Inmaculada Sánchez-Guerrero, Carlos Senent, Juan Serra, José Serrano, Pere Simonet, José Soto, Javier Subiza, Ana Tabar, Rosario Timiraos, Cristóbal Trillo, Isabel Urrutia, Luis Valdés, Joan Valldeperas, Rosario Vargas, Arancha Vega, José Vega, Héctor Verea, Juan Vicente, Carmen Vidal, Laura Vigil, Concepción Vila, Rosa Villafàfila, Carlos Villasante, José Zubeldia

Abstract

Introduction: Asthma Control Questionnaire (ACQ) is a validated tool to measure asthma control. Cut-off points that best discriminate "well-controlled" or "not well-controlled" asthma have been suggested from the analysis of a large randomized clinical trial but they may not be adequate for daily clinical practice.

Aims: To establish cut-off points of the ACQ that best discriminate the level of control according to Global Initiative for Asthma (GINA) 2006 guidelines in patients with asthma managed at Allergology and Pulmonology Departments as well as Primary Care Centers in Spain.

Patients and methods: An epidemiological descriptive study, with prospective data collection. Asthma control following GINA-2006 classification and 7-item ACQ was assessed. The study population was split in two parts: 2/3 for finding the cut-off points (development population) and 1/3 for validating the results (validation population).

Results: A total of 1,363 stable asthmatic patients were included (mean age 38 ± 14 years, 60.3% women; 69.1% non-smokers). Patient classification according to GINA-defined asthma control was: controlled 13.6%, partially controlled 34.2%, and uncontrolled 52.3%. The ACQ cut-off points that better agreed with GINA-defined asthma control categories were calculated using receiver operating curves (ROC). The analysis showed that ACQ < 0.5 was the optimal cut-off point for "controlled asthma" (sensitivity 74.1%, specificity 77.5%) and 1.00 for "uncontrolled asthma" (sensitivity 73%, specificity 88.2%). Kappa index between GINA categories and ACQ was 0.62 (p < 0.001).

Conclusion: The ACQ cut-off points associated with GINA-defined asthma control in a real-life setting were <0.5 for controlled asthma and ≥1 for uncontrolled asthma.

Figures

Figure 1
Figure 1
Strobe flow chart.
Figure 2
Figure 2
Asthma control: 2a) According to GINA 2006 guidelines and 2b) In each step of the treatment.2a) Asthma control according to GINA 2006 (N = 855). 2b) Asthma control according to treatment step (N = 624).
Figure 3
Figure 3
Perception of asthma control according to patients’ and physicians’ perceptions.
Figure 4
Figure 4
ACQ cut-off points obtained in the development and validation population.4a) Uncontrolled vs.controlled. 4b) Uncontrolled vs. partially controlled. 4c) ACQ-7 vs ACQ-5.

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Source: PubMed

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