Tracing Uncontrolled Asthma in Family Practice Using a Mailed Asthma Control Questionnaire

Lotte van den Nieuwenhof; Tjard Schermer; Marianne Heins; Joke Grootens; Petra Eysink; Ben Bottema; Chris van Weel; Patrick Bindels

doi:10.1370/afm.776

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Figure 1.
Patient flow.

ACQ = Asthma Control Questionnaire.¹⁴^,¹⁶
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Figure 2.
Distribution of ACQ sum scores among all respondents with a complete ACQ (n = 326).

ACQ = Asthma Control Questionnaire.¹⁴^,¹⁶  Note: Dashed line indicates ACQ cutoff value for asthma patients with suboptimal asthma symptom control (>3 points).¹³

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Table 1.

Asthma Control Questionnaire¹⁶^–¹⁸

1. On average, during the past week, how often were you woken by your asthma during the night?	0 Never  1 Hardly ever  2 A few times  3 Several times  4 Many times  5 A great many times  6 Unable to sleep because of asthma
2. On average, during the past week, how bad were your asthma symptoms when you woke up in the morning?	0 No symptoms  1 Very mild symptoms  2 Mild symptoms  3 Moderate symptoms  4 Quite severe symptoms  5 Severe symptoms  6 Very severe symptoms
3. In general, during the past week, how limited were you in your activities because of your asthma?	0 Not limited at all  1 Very slightly limited  2 Slightly limited  3 Moderately limited  4 Very limited  5 Extremely limited  6 Totally limited
4. In general, during the past week, how much shortness of breath did you experience because of your asthma?	0 None  1 A very little  2 A little  3 A moderate amount  4 Quite a lot  5 A great deal  6 A very great deal
5. In general, during the past week, how much of the time did you wheeze?	0 Never  1 Hardly any of the time  2 A little of the time  3 A moderate amount of the time  4 A lot of the time  5 Most of the time  6 All the time
6. On average, during the past week, how many puffs/inhalations of short-acting bronchodilator (eg, Ventolin, Bricanyl) have you used each day? (If you are not sure how to answer this question, please ask for help.)	0 None  1 1–2 puffs/inhalations most days  2 3–4 puffs/inhalations most days  3 5–8 puffs/inhalations most days  4 9–12 puffs/inhalations most days  5 13–16 puffs/inhalations most days  6 More than 16 puffs/inhalations most days

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Table 2.

Characteristics of All Patients Sent the ACQ and of Respondents and Nonrespondents

		Group
Characteristic	Total (N = 434)	Nonrespondents (n = 101)	*Respondents (n = 333)**	P Value
ACQ = Asthma Control Questionnaire.¹⁴^,¹⁶
Note: Values are % (No.) unless indicated otherwise.
* Primary and secondary respondents combined.
† Calculated with the χ² test.
‡ Calculated with the 1-way analysis of variance test.
§ Patients who visited their family physician for respiratory complaints, including visits for asthma exacerbations.
\|\| In the 2 years preceding the ACQ mailing.
¶ Calculated with the Mann-Whitney U test.
# Receipt of at least 1 prescription for a bronchodilator or an inhaled steroid in the 2 years preceding the ACQ mailing.
** Proportion of inhaled steroid users; dosing groups are based on the Global Initiative for Asthma (GINA) classification.¹⁹
†† At least 1 exacerbation for which prednisolone or antibiotics were prescribed.
Female	58.5 (254)	45.5 (46)	62.5 (208)	.003^†
Age, mean (SD), years	34.1 (7.5)	32.6 (7.5)	34.6 (7.5)	.02^‡
Visitors^§	47.7 (207)	47.5 (48)	47.7 (159)	.97^†
Consultations, ^\|\| mean (SD), No.	1.1 (1.8)	1.0 (1.6)	1.2 (1.9)	.45^¶
Use of any asthma medication^#	75.3 (327)	61.4 (62)	79.6 (265)	<.001^†
Use of inhaled steroid	26.0 (113)	16.8 (17)	28.8 (96)	.02^†
Low dose^**	8.5 (37)	17.6 (3)	35.8 (34)	–
Intermediate dose^**	9.4 (41)	29.5 (5)	37.9 (36)	.08^†
High dose^**	7.8 (34)	52.9 (9)	26.4 (25)	–
Short-acting bronchodilator	23.7 (103)	19.8 (20)	24.9 (83)	.29^†
Long-acting β₂ agonist	6.0 (26)	5.0 (5)	6.3 (21)	.61^†
Asthma exacerbation^††	12.0 (52)	8.9 (9)	12.9 (43)	.28^†
ACQ sum score, mean (SD)	–	–	5.2 (5.2)	–

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Table 3.

Characteristics of Primary Respondents and Secondary Respondents

Characteristic	Primary Respondents (n=244)	Secondary Respondents (n=89)	P Value
ACQ = Asthma Control Questionnaire.¹⁴^,¹⁶
Note: Values are % (No.) unless indicated otherwise.
* Calculated with χ² test.
† Calculated with 1-way analysis of variance test.
‡ Patients who visited their family physician for respiratory complaints, including visits for asthma exacerbations.
§ In the 2 years preceding ACQ mailing. Calculated with Mann-Whitney U test.
¶ At least 1 prescription for a bronchodilator or an inhaled steroid in the 2 years preceding the ACQ mailing.
# At least 1 exacerbation for which prednisolone or antibiotics were prescribed.
Female	65.2 (159)	55.1 (49)	.09*
Age, mean (SD), years	34.6 (7.3)	34.6 (8.1)	.94^†
Visitors^‡	50.4 (123)	40.4 (36)	.11*
Consultations,^§ mean (SD), No.	1.3 (2.1)	0.8 (1.2)	.03^\|\|
Use of any asthma medication^¶	83.2 (203)	69.7 (62)	.007*
Asthma exacerbation^#	13.9 (34)	10.1 (9)	.46*
ACQ sum score, mean (SD)	5.3 (5.3)	4.8 (5.2)	.49^\|\|