Identifying well-controlled and not well-controlled asthma using the Asthma Control Questionnaire

yes platform+medline author author

Elizabeth F. Juniper ,

Jean Bousquet ,

Linda Abetz ,

Eric D. Bateman ,

The GOAL Committee

Received 13 May 2005; accepted 6 August 2005. published online 14 October 2005.

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Summary
The 7-item Asthma Control Questionnaire (ACQ) has been validated to measure the goals of asthma management as defined by international guidelines (minimisation of day- and night-time symptoms, activity limitation, 2-agonist use and bronchoconstriction). Responses are given on a 7-point scale and the overall score is the mean of the responses (0=totally controlled, 6=severely uncontrolled). The aim of this analysis was to determine the cut-point on the ACQ that best differentiates between well -controlled and not well-controlled for (a) clinical practice (low risk of missing not well -controlled) and (b) clinical trials (low risk of including well controlled). All 1323 patients who provided data sets at week 12 in the Gaining Optimal Asthma Control (G OAL) clinical trial were included in the analysis. The gold standard for well -controlled was a composite based on the GINA/NIH guidelines and derived from data collected in the clinical trial diaries and clinic records. The analysis showed that the crossover point between well-controlled and not well-controlled is close to 1.00 on the ACQ. However, to be confident that a patient has well-controlled asthma, the optimal cut-point is 0.75 (negative predictive value=0.85). To be confident that the patient has inadequately controlled asthma, the optimal cut-point is 1.50 (positive predictive value=0.88). In conclusion, knowledge of these cut-points will enhance practising clinicians ability to identify patients whose asthma requires additional treatment, enable investigators to enroll poorly controlled patients into studies and for both clinicians and investigators to evaluate whether treatment goals are being achieved.
Keywords: Asthma, Questionnaire, Measurement

Development and validation of the mini Rhinoconjunctivitis Quality of Life Questionnaire.

Juniper EF, Thompson AK, Ferrie PJ, Roberts JN.

Source
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

Abstract
BACKGROUND:
The 28-item Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) has strong measurement properties but for large clinical trials, surveys and practice monitoring, where high efficiency is important, a shorter questionnaire is needed.

OBJECTIVE:
To develop and validate an abbreviated version of the RQLQ.

METHODS:
Using five RQLQ databases, items with high item-item correlations were combined and then the highest scoring items were selected for the MiniRQLQ (14 questions). There are five domains: activity limitations (standardized), practical problems and nose symptoms, eye symptoms and other symptoms. The MiniRQLQ, which is selfadministered, was tested in a 5-week observational study in 100 adults with symptomatic rhinoconjunctivitis. Patients completed the MiniRQLQ, the RQLQ, and other measures of health status at baseline, 1 and 5 weeks.

RESULTS:
In patients whose rhinoconjunctivitis was stable between clinic visits, reliability (reproducibility and ability to discriminate between patients of different impairment) was very acceptable for the MiniRQLQ (ICC = 0.93) but not quite as good as for the RQLQ (ICC = 0.97). Responsiveness to change in clinical status was better with the

MiniRQLQ than the RQLQ (P = 0. 044). Construct validity (correlation with other indices of health status) was strong for both the MiniRQLQ and the RQLQ. Concordance between the two instruments was high (ICC = 0.87).

CONCLUSIONS:
The MiniRQLQ has strong measurement properties and measures the same construct as the original RQLQ. The choice of questionnaire should depend on the task at hand.

PMID:

10606940

[PubMed - indexed for MEDLINE

Development and validation of the mini Rhinoconjunctivitis Quality of Life Questionnaire. E F Juniper, A K Thompson, P J Ferrie and J N Roberts Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. AbstractBuy the PDF

Pubmed abstract Get permission Buy the PDF PDF from publisher Suppl. info HTML version PMID: 10606940

BACKGROUND: The 28-item Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) has strong measurement properties but for large clinical trials, surveys and practice monitoring, where high efficiency is important, a shorter questionnaire is needed. OBJECTIVE: To develop and validate an abbreviated version of the RQLQ. METHODS: Using five RQLQ databases, items with high item-item correlations were combined and then the highest scoring items were selected for the MiniRQLQ (14 questions). There are five domains: activity limitations (standardized), practical problems and nose symptoms, eye symptoms and other symptoms. The MiniRQLQ, which is self-administered, was tested in a 5-week observational study in 100 adults with symptomatic rhinoconjunctivitis. Patients completed the MiniRQLQ, the RQLQ, and other measures of health status at baseline, 1 and 5 weeks. RESULTS: In patients whose rhinoconjunctivitis was stable between clinic visits, reliability (reproducibility and ability to discriminate between patients of different impairment) was very

acceptable for the MiniRQLQ (ICC = 0.93) but not quite as good as for the RQLQ (ICC = 0.97). Responsiveness to change in clinical status was better with the MiniRQLQ than the RQLQ (P = 0. 044). Construct validity (correlation with other indices of health status) was strong for both the MiniRQLQ and the RQLQ. Concordance between the two instruments was high (ICC = 0.87). CONCLUSIONS: The MiniRQLQ has strong measurement properties and measures the same construct as the original RQLQ. The choice of questionnaire should depend on the task at hand. DOI: 10.1046/j.1365-2222.2000.00668.x

Development and validation of the Mini Asthma Quality of Life Questionnaire.

Juniper EF, Guyatt GH, Cox FM, Ferrie PJ, King DR.

Source
Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

Abstract
The 32-item Asthma Quality of Life Questionnaire (AQLQ) has shown good responsiveness, reliability and construct validity; properties that are essential for use in clinical trials, clinical practice and surveys. However, to meet the needs of large clinical trials and long-term monitoring, where efficiency may take precedent over precision of measurement, the 15-item self-administered MiniAQLQ has been developed. The MiniAQLQ was tested in a 9-week observational study of 40 adults with symptomatic asthma. Patients completed the MiniAQLQ, the AQLQ, the Short Form (SF)-36, the Asthma Control Questionnaire and spirometry at baseline, 1, 5 and 9 weeks. In patients whose asthma was stable between clinic visits, reliability was very acceptable for the MiniAQLQ (intraclass correlation coefficient (ICC)=0.83), but not quite as good as for the AQLQ (ICC=0.95). Similarly, responsiveness in the MiniAQLQ (p=0.0007) was good but not quite so good as for the AQLQ (p<0.0001). Construct validity (correlation with other indices of health status) was strong for both the MiniAQLQ and the AQLQ. Criterion validity showed that there was no bias between the instruments (p=0.61) and the correlation between them was high (r=0.90). The Mini Asthma Quality of Life Questionnaire has good measurement properties but they are not quite as strong as those of the original Asthma Quality of Life Questionnaire. The choice of questionnaire should depend on the task at hand.

PMID:

10489826

[PubMed - indexed for MEDLINE]

Free Article

Adult Asthma
Asthma is a condition characterized by (1) airways obstruction that is usually reversible, (2) chronic airway inflammation, and (3) non-specific airways hyperreactivity (National Asthma Education and Prevention Program. Guidelines for the diagnosis and management of asthma. Department of Health and Human Services Publication No. 91-3042, Bethesda, Maryland, 1991). Affected individuals typically report episodic attacks of wheezing, dyspnea, chest tightness and/or cough. Attacks may be precipitated by inhaled allergens, respiratory infections, cold air, exercise, and even emotional stress. For most individuals with asthma, these episodes are separated by long symptom-free periods. Yet the impact of asthma on the quality of life of patients with even mild disease may be considerable. Exacerbations may interfere with daily work, school, leisure and social activities. Furthermore, even when asthma is well controlled, chronic management often requires regular medication use, patient self-monitoring of peak expiratory flow rates, avoidance of environmental allergens and non-specific irritants, and frequent visits to health care providers. All of these may be burdensome for the affected individual, with respect to time, effort, and inconvenience. Ideally, asthma quality of life instruments should address both the impact of symptoms and the burdens of asthma management. When selecting instruments for use in asthma research, investigators should also consider the possibility that the effects of asthma and asthma interventions on quality of life may be small, since most asthmatic patients have mild, intermittent disease1. Thus, generic instruments developed for use in healthy populations may be suitable for some questions in asthma research. Conversely, disease-specific instruments may be very sensitive to change following asthma interventions and may prove to be especially valuable in this evaluative context. 1. Richards JM Jr., Hemstreet MP. Measures of life quality, role performance, and functional status in asthma research. Am J Respir Crit Care Med 1994;149:S31-9.

Generic Health-Related Quality of Life Instruments Used in Asthma

EuroQol (EQ-5D)

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Nottingham Health Profile

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Sickness Impact Profile

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Medical Outcomes Study SF-36

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15D

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Condition-Specific Health-Related Quality of Life Instruments Used in Asthma

Airways Questionnaire

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Asthma Bother Profile

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Asthma Quality of Life Questionnaire [Juniper's]

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Montelukast/Beclomethasone Study Group. Ann Intern Med 1999;130(6):487-95. Malo JL, Boulet LP, Dewitte JD, Cartier A, L'Archeveque J, Cote J, Bedard G, Boucher S, Champagne F, Tessier G, et al. Quality of life of subjects with occupational asthma. J Allergy Clin Immunol 1993;91(6):1121-7. Mancuso CA, Peterson MG, Charlson ME. Comparing discriminative validity between a disease-specific and a general health scale in patients with moderate asthma. J Clin Epidemiol. Mar 2001;54(3):263-274. Mancuso CA, Peterson MGE, Charlson ME. Effects of depressive symptoms on health-related quality of life in asthma patients. J Gen Intern Med 2000;15:301-310. Mancuso CA, Rincon M, et al. Self-efficacy, depressive symptoms, and patients' expectations predict outcomes in asthma. Med Care 2001;39(12): 1326-38. McFadden ER, Casale TB, Edwards TB, Kemp JP, Metzber WG, Nelson HS, Storms WW, Neidl M. Administration of budesonide once daily by means of Turbuhaler to subjects with stable asthma. J Allergy Clin Immunol 1999;104:46-52. McColl E, Eccles MP, Rousseau NS, Steen IN, Parkin DW, Grimshaw JM. From the generic to the conditionspecific?: Instrument order effects in Quality of Life Assessment. Med Care. 2003;41(7):777-90. Meltzer EO, Lockey RF, Friedman BF, et al. Efficacy and safety of low-dose fluticasone propionate compared with montelukast for maintenance treatment of persistent asthma. Mayo Clin Proc. May 2002;77(5):437445. Meyer IH, Sternfels P, Fagan JK, Ford JG. Asthma-related limitations in sexual functioning: an important but neglected area of quality of life. Am J Public Health. May 2002;92(5):770-772. Moudgil H, Marshall T, Honeybourne D. Asthma education and quality of life in the community: a randomised controlled study to evaluate the impact on white European and Indian subcontinent ethnic groups from socioeconomically deprived areas in Birmingham, UK. Thorax 2000;55:177-83. Moy ML, Israel E, Weiss ST, Juniper EF, Dube L, Drazen JM. Clinical predictors of health-related quality of life depend on asthma severity. Am J Respir Crit Care Med. Mar 2001;163(4):924-929. Nathan RA, Bernstein JA, Bielory L, Bonuccelli CM, Calhoun WJ, Galant SP, Hanby LA, Kemp JP, Kylstra JW, Nayak AS, O'Connor JP, Schwartz HJ, Southern DL, Spector SL, Williams PV. Zafirlukast improves asthma symptoms and quality of life in patients with moderate reversible airflow obstruction. J Allergy Clin Immunol 1998;102(6 Pt 1):935-42. Nelson HS, Busse WW, deBoisblanc BP, Berger WE, Noonan MJ, Webb DR, Wolford JP, Mahajan PS, Hamedani AG, Shah T, Harding SM Fluticasone propionate powder: oral corticosteroid-sparing effect and improved lung function and quality of life in patients with severe chronic asthma. J Allergy Clin Immunol 1999;103(2 Pt 1):267-75. Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T, Mishima M. A comparison of the responsiveness of different generic health status measures in patients with asthma. Qual Life Res. 2003;12(5):555-63. Oga T, Nishimura K. et al Comparison of the responsiveness of different disease-specific health status measures in patients with asthma, Chest 2002 122:1228-1233. Perneger TV, Sudre P, Muntner P, et al. Effect of patient education on self-management skills and health status in patients with asthma: a randomized trial. Am J Med. Jul 2002;113(1):7-14. Put C, Demedts M, van den Bergh O, Demyttenaere K, Verleden G. Asthma symptoms: influence of personality versus clinical status. Eur Respir J 1999;13:751-6. Put C, Van den Bergh O, Demedts M, Verleden G. A study of the relationship among self-reported noncompliance, symptomatology, and psychological variables in patients with asthma. Journal of Asthma 2000;37(3):503-510. Riccioni G, D'Orazio N, Di Ilio C, Menna V, Guagnano MT, Della Vecchia R. (2004). Quality of Life and clinical symptoms in asthmatic subjects. J Asthma. 41(1):85-9. Rimington LD, Davies DH, Lowe D, Pearson MG. Relationship between anxiety, depression, and morbidity in adult asthma patients. Thorax 2001;56:266-271. Rowe BH, Bota GW, Fabris L, Therrien SA, Milner RA, Jacono J. Inhaled budesonide in addition to oral corticosteroids to prevent asthma relapse following discharge from the emergency department: a randomized controlled trial. JAMA 1999;281(22):2119-26. Rowe BH, Oxman AD. Performance of an asthma quality of life questionnaire in an outpatient setting. Am Rev Respir Disease 1993;148(3):675-81. Sanjuas C, Alonso J, et al . Health related quality of life in asthma" a comparisons between the St. George's Respiratory Questionnaire and the Asthma Quality of Life Questionnaire. Qual Life Res 2002 11: 729-738. Sanjuas C, Alonso J, Ferrer M, Curull V, Broquetas JM, Anto JM. Adaptation of the Asthma Quality of Life Questionnaire to a second language preserves its critical properties: the Spanish version. J Clin Epidemiol. Feb 2001;54(2):182-189. Sen SS, Gupchup GV, Thomas J, 3rd. Selecting among health-related quality-of-life instruments. Am J Health Syst Pharm. 1999;56:1965-70; quiz 1971.

Sippel JM, Pedula KL, Vollmer WM, Buist AS, Osborne ML Associations of smoking with hospital-based care and quality of life in patients with obstructive airway disease. Chest 1999;115(3):691-6. Stahl E, Postma DS, Svensson K, et al. Formoterol used as needed improves health-related quality of life in asthmatic patients uncontrolled with inhaled corticosteroids. Respir Med. 2003;97(9):1061-6. Tan WC, Tan JW, Wee EW, Niti M, Ng TP. (2004) Validation of the English version of the Asthma Quality of Life Questionnaire in a multi-ethnic Asian population. Qual Life Res. 13(2):551-6. Tomic Spiric V, Bogic M, Jankovic S, Maksimovic N, Matovic Miljanovic S, Peric Popadic A, Raskovic S, Milic N. (2004) Assessment of the Asthma Quality of Life Questionnaire (AQLQ): Serbian translation. Croat Med J. 45(2):188-94. Turner MO, Taylor D, Bennett R, Fitzgerald JM. A randomized trial comparing peak expiratory flow and symptom self-management plans for patients with asthma attending a primary care clinic. Am J Respir Crit Care Med 1998;157(2):540-6. Vandenplas O, Jamart J, Delwiche JP, Evrard G, Larbanois A. Occupational asthma caused by natural rubber latex: outcome according to cessation or reduction of exposure. J Allergy Clin Immunol. Jan 2002;109(1):125-130. van der Molen T, Sears MR, de Graaff CS, Postma DS, Meyboom-de Jong B, for the Canadian and the Dutch Formoterol Investigators. Quality of life during formoterol treatment: comparison between asthma-specific and generic questionaires. Eur Respir J 1998;12:30-4. Vollmer WM, Markson LE, O'Connor E, et al. Association of asthma control with health care utilization and quality of life. Am J Respir Crit Care Med. 1999;160:1647-52. Wasserfallen J, Gold K, Schulman KA, Baraniuk JN. Item responsiveness of a rhinitis and asthma symptom score during a pollen season. J Asthma 1999;36(5):459-65. Wenzel SE, Lumry W, Manning M, Kalberg C, Cox F, Emmett A, Rickard K. Efficacy, safety, and effects on quality of life of salmeterol versus albuterol in patients with mild to moderate persistent asthma. Ann Allergy Asthma Immunol 1998;80(6):463-70. Wyrwich KW, Tierney WM, Wolinsky FD. Using the standard error of measurement to identify important changes on the Asthma Quality of Life Questionnaire. Qual Life Res. Feb 2002;11(1):1-7.

Asthma Quality of Life Questionnaire [Marks']

Abdulwadud OA, Abramson MJ, Light L, Thien FC, Walters EH. Comparison of patients with asthma managed in general practice and in a hospital clinic. Med J Aust. 1999;171:72-5. Adams RJ, Ruffin RE, Smith BJ. Validity of a modified version of the Marks Asthma Quality of Life Questionnaire. J Asthma 2000;37(2):131-43. Blanc PD, Trupin L, Earnest G, et al. Effects of physician-related factors on adult asthma care, health status, and quality of life. Am J Med. 2003;114(7):581-7. Gupchup GV, Hubbard JH, Teel MA, Singhal PK, Tonrey L, Riley K, Rupp MT, Coultas DB. Developing a community-specific health-related quality of life (HRQOL) questionnaire for asthma: the asthma-specific quality of life questionnaire for Native American adults (AQLQ-NAA). 2001;38(2):169-178. Gupchup GV, Wolfgang AP, Thomas J III. Reliability and validity of the Asthma Quality of Life Questionnaire-Marks in a sample of adult asthmatic patients in the United States. Clin Ther 1997;19(5):1116-25. Jowers JR, Schwartz AL, Tinkelman DG, Reed KE, Corsello PR, Mazzei AA, Bender DR, Lochhead RA. Disease management program improves asthma outcomes. Am J Manag Care 2000;6:585-92. Katz P Yelin E, et al . Perceived control of asthma and quality of life among adults with asthma. Ann Allergy Asthma Immunol 89:251-258. 2002 Katz PP, Eisner MD, Henke J, Shiboski S, Yelin EH, Blanc PD. The Marks Asthma Quality of Life Questionnaire: further validation and examination of responsiveness to change. J Clin Epidemiol 1999;52(7):667-75. Marks GB, Heslop W, Yates DH. Prehospital management of exacerbations of asthma: relation to patient and disease characteristics. Respirology 2000;5:45-50. Marks GB, Mellis C, Peat JK, Woolcock AJ, Leeder SR. A profile of asthma and its management in a New South Wales provincial centre Med J Australia 1994;160(5):260-4, 268. Marks GB, Dunn SM, Woolcock AJ. An evaluation of an asthma quality of life questionnaire as a measure of change in adults with asthma. J Clin Epidemiol 1993;46(10):1103-11. Osborne ML, Vollmer WM, Linton KLP, Buist S. Characteristics of patients with asthma within a large HMO. Am J Respir Crit Care Med 1998;157;123-8. Premaratne UN, Sterne JAC, Marks GB, Webb JR, Azima H, Burney PGJ. Clustered randomised trial of an intervention to improve the management of asthma: Greenwich asthma study. BMJ 1999;318:1251-5. Richter B, Bender R, Berger M. Effects of on-demand B2-agonist inhalation in moderate-to-severe asthma. A

randomized controlled trial. J Intern Med 2000;247:657-66. Sen SS, Gupchup GV, Thomas J, 3rd. Selecting among health-related quality-of-life instruments. Am J Health Syst Pharm. 1999;56:1965-70; quiz 1971. Wolf BL, Reed G. Asthma quality of life in a Southern practice: towards a new paradigm. Ann Allergy Asthma Immunol. 1999;83:371-6.

Adolescent Quality of Life Questionnaire

Tierney WM, Roesner JF, Seshadri R, Lykens MG, Murray MD, Weinberger M. (2004) Assessing symptoms and peak expiratory flow rate as predictors of asthma exacerbations. J Gen Intern Med. 19(3):237-42.

Asthma Technology of Patient Experience (Asthma TyPE)

Zillich AJ, Blumenschein K, Johannesson M, Freeman P. Assessment of the relationship between measures of disease severity, quality of life, and willingness to pay in asthma. Pharmacoeconomics. 2002;20(4):257-265.

Integrated Therapeutics Group - Asthma Short Form (ITG-ASF)

Eisner MD, Ackerson LM, Chi F, et al. Health-related quality of life and future health care utilization for asthma. Ann Allergy Asthma Immunol. Jul 2002;89(1):46-55. Kanter L, Siegel C, et al Impact of respiratory symptoms on heath related quality of life and medical resource utilization of patients treated by allergy specialists and primary care providers. Ann Allergy Asthma Immunol 89:139-147. 2002

Living with Asthma Questionnaire

Didier A, Campos Oriola R. A two-month comparison of salmeterol/beclomethasone and slow-release terbutaline/budesonide in moderate asthma management. Clin Drug Invest 1997;14(1):1-11. Hyland ME, Crocker GR. Validation of an asthma quality of life diary in a clinical trial. Thorax 1995;50(7):724-30. Hyland ME, Kenyon CA, Jacobs PA. Sensitivity of quality of life domains and constructs to longitudinal change in a clinical trial comparing salmeterol with placebo in asthmatics. Qual Life Res 1994;3(2):121-6. Mahajam P, Okamoto LH, Schaberg A, Kellerman D, Schoenwetter WF. Impact of fluticasone propionate powder on health-related quality of life in patients with moderate asthma. J Asthma 1997;34(3):227-34. Nishimura K, Hajiro T, Oga T, Tsukino M, Ikeda A. (2004) Health-related quality of life in stable asthma: what are remaining quality of life problems in patients with well-controlled asthma? J Asthma. 41(1):57-65. Oga T, Nishimura K. et al Comparison of the responsiveness of different disease-specific health status measures in patients with asthma, Chest 2002 122:1228-1233. Palmer JBD, Hyland ME. Salmeterol in clinical practice: comparator and safety studies, quality of life studies. Eur Respir Rev 1991;1(4):301-303. Ried LD, Nau DP, Grainger-Rousseau TJ. Evaluation of patient's Health-Related Quality of Life using a modified and shortened version of the Living With Asthma Questionnaire (ms-LWAQ) and the medical outcomes study, Short-Form 36 (SF-36). Qual Life Res. 1999;8:491-9. Sen SS, Gupchup GV, Thomas J, 3rd. Selecting among health-related quality-of-life instruments. Am J Health Syst Pharm. 1999;56:1965-70; quiz 1971. van der Molen T, Sears MR, de Graaff CS, Postma DS, Meyboom-de Jong B, for the Canadian and the Dutch Formoterol Investigators. Quality of life during formoterol treatment: comparison between asthma-specific and generic questionaires. Eur Respir J 1998;12:30-4. Vazquez MI. Relationship between psychological variables relevant to asthma and patients' quality of life. Psychological Reports 2000;86:31-33. Vermetten FAAM, Boermans AJM, Luiten WDVF, Mulder PGH, Vermue NA. Comparison of salmeterol with beclomethasone in adult patients with mild persistent asthma who are already on low-dose inhaled steroids. J Asthma 1999;36(1):97-106. Boulet L, Boulet V et al. How should we quantify asthma control: A proposal. Chest 2002 122:2217-2223.

Quality of Life in Respiratory Illness Questionnaire

van Stel H, Maille A, et al. Interpretation of change and longitudinal validity of the quality of life for respiratory illness questionnaire (QoLRIQ) in inpatient pulmonary rehabilitation. Qual Life Res. 2003; 12:133-145. Wijnhoven HAH, Kriegsman DMW, Hesselink AE, Penninx BWJH, de Haan M. Determinants of different dimensions of disease severity in asthma and COPD. Chest 2001;119:1034-1042.

Rhinasthma

Baiardini I, Pasquali M, Giardini A, et al. Rhinasthma: a new specific QoL questionnaire for patients with rhinitis and asthma. Allergy. 2003;58(4):289-94.

St. George's Respiratory Questionnaire

Anie KA, Jones PW, Hilton SR, Anderson HR. A computer-assisted telephone interview technique for assessment of asthma morbidity and drug use in adult asthma. J Clin Epidemiol 1996;49(6):653-6. Barley EA, Jones PW. A comparison of global questions versus health status questionnaires as measures of the severity and impact of asthma. Eur Respir J. 1999;14:591-6. de Oliveira MA, Faresin SM, Bruno VF, de Bittencourt AR, Fernandes AL. Evaluation of an educational programme for socially deprived asthma patients. Eur Respir J. 1999;14:908-14. Durna Z, Ozcan S. Evaluation of self-management education for asthmatic patients. J Asthma. 2003;40(6):631-43. Dyer CA, Hill SL, Stockley RA, Sinclair AJ. Quality of life in elderly subjects with a diagnostic label of asthma from general practice registers. Eur Respir J. 1999;14:39-45. Gallefoss F, Bakke PS, Kjaersgaard P. Quality of life assessment after patient education in a randomized controlled study on asthma and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;169:812-7. Huang CJ, Wang CH, Liu WT, et al. Zafirlukast improves pulmonary function in patients with moderate persistent asthma receiving regular inhaled steroids: a prospective randomized control study. Chang Gung Med J. 2003;26(8):554-60. Jones, P. Interpreting thresholds for a clinically significant change in health status in asthma and COPD Eur Respir J 2002: 19: 398-404. Jones PW. Quality of life, symptoms and pulmonary function in asthma: longterm treatment with nedocromil sodium examined in a controlled multicentre trial. Nedocromil Sodium Quality of Life Study Group. Eur Respir J 1994;7(1):55-62. Kanter L, Siegel C, et al Impact of respiratory symptoms on heath related quality of life and medical resource utilization of patients treated by allergy specialists and primary care providers. Ann Allergy Asthma Immunol. 89:139-147. 2002. Kauppinen R, Vilkka V, Sintonen G, Klaukka T, Tukiainen H. Long-term economic evaluation of intensive patient education during the first treatment year in newly diagnosed adult asthma. Respiratory Medicine 2001;95:56-63. Kauppinen R, Sintonen H, Vilkka V, Tukiainen H. Long-term (3-year) economic evaluation of intensive patient education for self-management during the first year in new asthmatics. Respir Med. 1999;93:283-9. Koskela T, Hedman J, Ekroos H, et al. Equivalence of two steroid-containg inhalers: Easyhaler multidose powder inhalder compared with conventional aerosol with large-volume spacer. Respiration 2000;67:194202. Molimard M, Bourcereau J, Le Gros V, Bourdeix I, Leynadier F, Duroux P. Comparison between formoterol 12 ug bid and on-demand salbutamol in moderate persistant asthma. Respiratory Medicine 2001;95:64-70. Nishimura K, Hajiro T, Oga T, Tsukino M, Ikeda A. (2004) Health-related quality of life in stable asthma: what are remaining quality of life problems in patients with well-controlled asthma? J Asthma. 41(1):57-65. Osman LM, Calder C, Robertson R, et al. Symptoms, quality of life, and health service contact among young adults with mild asthma. Am J Respir Crit Care Med 2000;161:498-503. Plaza V, Serra-Batlles J, Ferrer M, Morejon E. Quality of life and economic features in elderly asthmatics. Respiration 2000;67:65-70. Richter B, Bender R, Berger M. Effects of on-demand B2-agonist inhalation in moderate-to-severe asthma. A randomized controlled trial. J Intern Med 2000;247:657-66. Sanjuas C, Alonso J, et al. Health related quality of life in asthma: a comparison between the St. George's

Respiratory Questionnaire and the Asthma Quality of Life Questionnaire. Qual Life Res. 2002 11: 729-738. Sanjuas C, Alonso J, Ferrer M, Curull V, Broquetas JM, Anto JM. Adaptation of the Asthma Quality of Life Questionnaire to a second language preserves its critical properties: the Spanish version. J Clin Epidemiol. Feb 2001;54(2):182-189. Vollmer WM, Markson LE, O'Connor E, et al. Association of asthma control with health care utilization and quality of life. Am J Respir Crit Care Med. 1999;160:1647-52. Wang KY , Wu CP, Tang YY, Yang ML. (2004) Health-related quality of life in Taiwanese patients with bronchial asthma. J Formos Med Assoc. 103(3):205-11.

Copyright 2007 American Thoracic Society Web Site Requirements

Asthma Quality of Life Questionnaire [Juniper's]

Name of Questionnaire
Asthma Quality of Life Questionnaire (AQLQ)

Description
A disease-specific health-related quality of life instrument developed by E. Juniper and colleagues that taps both physical and emotional impact of disease. The instrument should not be confused with the measure developed by Marks and colleagues, which carries the same name.

Developer(s)
E Juniper, G Guyatt, P Ferrie, L Griffith 2

Address
Elizabeth Juniper MCSP Msc 20 Marcuse Fields Bosham, West Sussex PO18 8NA, England Tel: +44 1243 572124; Fax: +44 1243 573680

E-mail
juniper@QolTech.co.uk

URL
http://www.qoltech.co.uk/

Cost & availability

Not reported.

Administration
7

Time to complete
Not reported.

Number of items
Not reported.

Domains & categories (#)

Not reported.

Name of categories/domains
Symptoms, emotions, exposure to environmental stimuli, activity limitation

Scaling of items
7-point Likert scale

Scoring
All items are weighted equally. Mean score is calculated across all items within each domain. Overall score is the mean across all items.

Reliability
a. Test-Retest/Reproducibility: Reported 2 b. Internal Consistency: Reported 2, 3

Validity
Established by comparison to conventional clinical asthma measures (symptoms, peak flow rates, medication use, PFT, airway responsiveness, global rating of asthma), generic HRQL measures (Rand; SIP)2,3, clinical sensibility of the measure6; symptoms & clinical efficacy13

Responsiveness
Reported4,13; minimal important difference determined to be 0.5. Change of 1.0 represents a moderate change; change greater than 2.0 represents large change.

Minimally important difference

Reflected by a change in score of 0.5 on a seven point scale
4

Research Use
Yes, including clinical trials
8-11

14

15

17

18

Clinical Use
Short version for clinical use has been developed: MiniAQLQ

Alternate Versions
AQLQ-S (Standardized version) 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: 1265-1270. MiniAQLQ Juniper EF, Guyatt GH, Cox FM, Ferrie PJ, King DR. Development and validation of the Mini Asthma Quality of Life Questionnaire. Eur Respir J. 1999;14:32-8.

Language(s)
Original: English (Canada) More than 30 translations are available; please see Professor Juniper's website for a complete list.

References
1. Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, Hiller TK. Evaluation of impairment of health-related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax 1992;47:76-83. 2. Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of life in asthma. Am Rev Respir Dis 1993;127:832-838. 3. Rowe BH, Oxman AD. Performance of an asthma quality of life questionnaire in an outpatient setting. Am Rev Respir Dis 1993; 148: 675-681. 4. Juniper EF, Guyatt GH, Willan A, Griffith LE. Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol 1994; 47: 81-87. 5. Barber BL, Santanello NC, Epstein RS. Impact of the global on patient perceivable change in an asthma specific QOL instrument. Quality of Life Res 1996; 115-122. 6. Rowe BH, Oxman AD. An assessment of the sensibility of a quality of life instrument. Am J Emerg Med 1993; 11: 374-380. 7. Cook DJ, Guyatt GH, Juniper E, Griffith L, McIroy W, Willan A, Jaeschke R, Epstein R. Interviewer versus self-administered questionnaires in developing a diseasespecific, health- related quality of life instrument for asthma. J Clin Epidemiol 1993;6: 529-534. 8. Juniper EF, Johnston PR, Borkhoff CM, Guyatt GH, Boulet LP, Haukioja. Quality of life in asthma clinical trials: comparison of salmeterol and salbutamol. Am J Respir Care Med 1995;151(1):66-70. 9. Rutten-van Molken, van Doorslaer EKA, Jansen MCC et al. Costs and effects of inhaled corticosteroids and bronchodilators in asthma and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995;151:975-82. 10. Drazen JM, Israel E, Boushey HM et al. Comparison of regularly scheduled with asneeded use of albuterol in mild asthma. N Engl J Med 1996;335:841-847. 11. Israel E, Cohn J, Dube L, Drazen JM. Effect of treatment with zileuton, a 5lipoxygenase inhibitor in patients with asthma. JAMA 1996;275:931-936. 12. Gibson PG. Talbot PI, Toneguzzi RC, Population Medicine Group 91C. Selfmanagement, autonomy, and quality of life in asthma. Chest 1995;107(4):10031008. 13. Rutten-van Mlken M, Custers F, Van Doorslaer E, Jansen C, Heurman L, Maesen F, Smeets J, Bommer A, Raaijmakers J. Comparison of performance of four instruments in evaluating the effects of salmeterol on asthma quality of life. Eur Respir J 1995;8:888-898. 14. Boulet L, Boutin H, Cote J, Leblanc P, Laviolette M. Evaluation of an asthma selfmanagement education program. J Asthma 1995;32(3):199-206. 15. Apter A, Reisine S, Willard A, Clive J, Wells M, Metersky M, McNally D, ZuWallack R. The effect of inhaled albuterol in moderate to severe asthma. J Allergy Clin Immunol 1996;98:295-301. 16. Leroyer C, Lebrun T, Proust A, Lenne X, Lucas E, Rio G, Dewitte J-D, Clavier J. Knowledge, self-management, compliance and quality of life in asthma: a crosssectional study of the French version of the Asthma Quality of Life Questionnaire. Qual Life Res 1988;7:267-72. 17. Kemp JP, Cook DA, Incaudo GA, Corren J, Kalberg C, Emmett A, Cox FM, Rickard K, Salmeterol Quality of Life Study Group. Salmeterol improves quality of life in patients with asthma requiring inhaled corticosteroids. J Allergy Clin Immunol 1998;101:188-95. 18. Turner MO, Taylor D, Bennett R, Fitzgerald JM. A randomized trial comparing peak expiratory flow and symptom self-management plans for patients with asthma attending a primary care clinic. Am J Respir Crit Care Med 1998;157:540-6.

Date of information