International guidelines on asthma management indicate that the primary goal of treatment should be optimum asthma control. The aim of this study was to develop and validate the Asthma Control Questionnaire (ACQ).The authors generated a list of all symptoms used to assess control and sent it to 100 asthma clinicians who were members of guidelines committees (18 countries). They scored each symptom for its importance in evaluating asthma control. From the 91 responses, the five highest scoring symptoms were selected for the ACQ. In addition, there is one question on b 2 -agonist use and another on airway calibre (total questions=7). The ACQ was tested in a 9-week observational study of 50 adults with symptomatic asthma. The ACQ and other measures of asthma health status were assessed at baseline, 1, 5 and 9 weeks.In patients whose asthma was stable between clinic visits, reliability of the ACQ was high (intraclass correlation coefficient (ICC)=0.90). The questionnaire was very responsive to change in asthma control (p<0.0001). Cross-sectional and longitudinal validity were supported by correlations between the ACQ and other measures of asthma health status being close to a priori predictions.In conclusion, the Asthma Control Questionnaire has strong evaluative and discriminative properties and can be used with confidence to measure asthma control. Eur Respir J 1999; 14: 902±907. International guidelines indicate that the primary goal of asthma treatment is to achieve optimum control (minimization of day and night time symptoms, bronchoconstriction and short-acting b-agonist use) and thus reduce the risk of life-threatening exacerbations and long-term morbidity [1±4]. COCKCROFT and SWYSTUN [5] have pointed out that asthma "control" concerns the adequacy of treatment, whilst "severity" concerns the underlying disease process: "the common perception that well-controlled asthma is synonymous with mild asthma and that poorly controlled asthma is synonymous with severe asthma is erroneous".A number of questionnaires are described as measuring "asthma severity". In some, the term "severity" has been used appropriately [6,7] and the instruments validated against other measures of airway pathology. No questionnaires have been specifically developed and validated to measure asthma control. Without such an instrument, a simple, quantified method for identifying patients at risk and for evaluating the effects of treatment has been lacking.The authors developed the Asthma Control Questionnaire (ACQ) using recognized procedures for questionnaire specification, item selection and scaling [8] and the authors have examined the measurement properties necessary for its use in clinical practice, clinical trials and cross-sectional surveys [9]. The aim was to develop a simple questionnaire that could be completed in the clinic without daily recordings of symptoms, medication use and airway calibre.
Background and aims-To develop and assess a disease specific instrument for measuring health related quality of life (HRQL) in patients with chronic liver disease (CLD). Methods-Based on responses from 60 patients with chronic liver disease, from 20 liver experts, and from a Medline search of the literature, items potentially aVecting the HRQL of these patients were identified. A separate sample of 75 patients identified which items they found problematic and rated their importance. Results were explored using factor analysis; domains were chosen and items placed within domains. Redundant questions were eliminated and the final questionnaire was pretested in 10 patients. Using this instrument, HRQL was assessed in a further 133 patients with various types and stages of liver disease. Results-Patients, experts, and the literature search identified 156 items of potential importance. Of these, 35 proved important to over 50% of 75 respondents in the item reduction sample. The factor analysis suggested six domains. After eliminating redundancies, the Chronic Liver Disease Questionnaire (CLDQ) included 29 items in the following domains: fatigue, activity, emotional function, abdominal symptoms, systemic symptoms, and worry. In pretesting, patients found the CLDQ clear and easy to complete in 10 minutes. In another 133 patients, the CLDQ showed a gradient between patients without cirrhosis, Child's A cirrhosis, and those with Child's B or C cirrhosis. CLDQ has evidence for moderate reliability at six months and seems to be responsive. Conclusion-The CLDQ is short, easy to administer, produces both a summary score and domain scores, and correlates with the severity of liver disease. (Gut 1999;45:295-300) Keywords: quality of life; liver disease; liver specific quality of life; well beingThe traditional "biomedical model" of health which is based on the basic sciences (molecular biology, genetics, physiology, biochemistry, etc.) is being integrated with the "social science model" of health, based on a psychosocial and economic foundation. This integrated approach to clinical practice and research in medicine requires not only monitoring the traditional physiological and biochemical outcomes but also health related quality of life (HRQL).
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. Eur Respir J 1999; 14: 32±38.
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