Each patient should be assessed to establish his or her current treatment regimen, adherence to the current regimen, and level of asthma control. A simplified scheme for recognizing controlled, partly controlled, and uncontrolled asthma in a given week is provided in Figure 2-5.1 This is a working scheme based on current opinion and has not been validated. Several composite control measures (e.g., Asthma Control Test2, Asthma Control Questionnaire3-5, Asthma Therapy Assessment Questionnaire6, Asthma Control Scoring System7) have been developed and are being validated for various applications, including use by health care providers to assess the state of control of their patients1 asthma and by patients for self-assessments as part of a written personal asthma action plan. Uncontrolled asthma may progress to the point of an exacerbation, and immediate steps, described in Component 4, should be taken to regain control.
| Characteristic | Controlled (All of the following) | Partly Controlled (Any measure present in any week) | Uncontrolled |
|---|---|---|---|
| Daytime symptoms | None (twice or less/week) | More than twice/week | Three or more features of partly controlled asthma present in any week |
| Limitations of activities | None | Any | |
| Nocturnal symptoms/awakening | None | Any | |
| Need for reliever/ rescue treatment |
None (twice or less/week) | More than twice/week | |
| Lung function (PEF or FEV1)‡ | Normal | < 80% predicted or personal best (if known) |
|
| Exacerbations | None | One or more/year* | One in any week† |
* Any exacerbation should prompt review of maintenance treatment to ensure that it is adequate.
† By definition, an exacerbation in any week makes that an uncontrolled asthma week.
‡ Lung function is not a reliable test for children 5 years and younger.
References:
1. GINA. Global Initiative for Asthma. www.ginasthma.com. Revised 2007.
2. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of the asthma control test: a survey for
assessing asthma control. J Allergy Clin Immunol 2004;113(1):59-65.
3. Juniper EF, Buist AS, Cox FM, Ferrie PJ, King DR. Validation of a standardized version of the Asthma Quality of Life Questionnaire. Chest 1999;115(5):1265-70.
4. Juniper EF, Bousquet J, Abetz L, Bateman ED. Identifying well-controlled and not well-controlled asthma using the Asthma Control Questionnaire. Respir Med 2005.
5. Juniper EF, Svensson K, Mork AC, Stahl E. Measurement properties and interpretation of three shortened versions of the
asthma control questionnaire. Respir Med 2005;99(5):553-8.
6. Vollmer WM, Markson LE, O'Connor E, Sanocki LL, Fitterman L, Berger M, et al. Association of asthma control with health
care utilization and quality of life. Am J Respir Crit Care Med 1999;160(5 Pt 1):1647-52.
7. Boulet LP, Boulet V, Milot J. How should we quantify asthma control? A proposal. Chest 2002;122(6):2217-23.
8. The Asthma Control Test. 2007.
9. Skinner EA, Diette GB, Algatt-Bergstrom PJ, Nguyen TT, Clark RD, Markson LE, et al. The Asthma Therapy Assessment Questionnaire (ATAQ) for children and adolescents. Dis Manag 2004;7:305–313.
10. Juniper EF, O’Byrne PM, Guyatt GH, Ferrie PJ, King DR. Development and validation of a questionnaire to measure asthma control. Eur Respir J 1999;14:902–907.