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Research ArticleOriginal Research

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 and Patrick Bindels
The Annals of Family Medicine January 2008, 6 (suppl 1) S16-S22; DOI: https://doi.org/10.1370/afm.776
Lotte van den Nieuwenhof
MD
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Tjard Schermer
PhD
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Marianne Heins
MSc
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Joke Grootens
Bc
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Petra Eysink
PhD
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Ben Bottema
MD, PhD
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Chris van Weel
MD, PhD
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Patrick Bindels
MD, PhD
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    Figure 1.

    Patient flow.

    ACQ = Asthma Control Questionnaire.14,16

  • Figure 2.
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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

Tables

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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
    • View popup
    Table 2.

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

    Group
    CharacteristicTotal (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.
    Female58.5 (254)45.5 (46)62.5 (208).003†
    Age, mean (SD), years34.1 (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 steroid26.0 (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 bronchodilator23.7 (103)19.8 (20)24.9 (83).29†
    Long-acting β2 agonist6.0 (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)–
    • View popup
    Table 3.

    Characteristics of Primary Respondents and Secondary Respondents

    CharacteristicPrimary 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.
    Female65.2 (159)55.1 (49).09*
    Age, mean (SD), years34.6 (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||
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The Annals of Family Medicine: 6 (suppl 1)
The Annals of Family Medicine: 6 (suppl 1)
Vol. 6, Issue suppl 1
1 Jan 2008
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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
The Annals of Family Medicine Jan 2008, 6 (suppl 1) S16-S22; DOI: 10.1370/afm.776

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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
The Annals of Family Medicine Jan 2008, 6 (suppl 1) S16-S22; DOI: 10.1370/afm.776
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