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Asthma Control Questionnaire in children: validation, measurement properties, interpretation

E.F. Juniper, K. Gruffydd-Jones, S. Ward, K. Svensson
European Respiratory Journal 2010 36: 1410-1416; DOI: 10.1183/09031936.00117509
E.F. Juniper
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  • For correspondence: juniper@qoltech.co.uk
K. Gruffydd-Jones
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S. Ward
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K. Svensson
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Tables

  • Table 1– Example of a question from the Asthma Control Questionnaire (ACQ) that required a supplement for children in the UK
    First, read each question to the child using the primary wording. If the child does not fully understand the question, read it again using the secondary wording shown in brackets.
     3 During the past week, how limited were you in your activities because of your asthma?
     3a (During the past week, how bothered were you in the things you do every day because of your asthma?)
    • The supplementary wording applies only to the UK English version. Questions that require a supplement vary between languages and countries. Reproduced with permission from E.F. Juniper. Copyright of the ACQ is held by E.F. Juniper, QOL Technologies Ltd.

  • Table 4– Comparison of the original Asthma Control Questionnaire (ACQ) and the shortened versions (0 = well controlled; 6 = extremely poorly controlled)
    QuestionnaireScore at baselineChange score between baseline and 4 weeksConcordance between ACQ and short versions at baseline (ICC)Difference between ACQ and short versionsDifference between change in ACQ and change in short versions between baseline and 4 weeks
    Mean±sdp-valueMean±sdp-value
    ACQ all questions1.76±0.71-0.53±1.17
    Symptoms alone1.88±0.81-0.70±1.290.930.12±0.260.0100.17±0.340.006
    Symptoms plus FEV1 % pred1.83±0.74-0.65±1.200.980.07±0.11<0.0010.11±0.17<0.001
    Symptoms plus SABA use1.79±0.77−0.56±1.250.960.03±0.210.380.03±0.230.49
    • Data are presented as mean±sd, unless otherwise stated. ICC: intraclass correlation coefficient; FEV1: forced expiratory volume in 1 s; % pred: % predicted; SABA: short-acting β2-agonist.

  • Table 2– UK English Asthma Control Questionnaire (ACQ): instructions for interviewers
    Asthma Control Questionnaire (for children aged 6–10 yrs)
    Please read these instructions carefully before administering the questionnaire
    Parents may be present during the interview but you should encourage the child to respond and only ask the parent to help if the child is having difficulties.
    Some younger children may have difficulty understanding the meaning of some questions. First, you should read each question to the child exactly as written in the text. If the child doesn't understand, read the question again using the secondary wording included in the brackets. Try not to place your own interpretation on the question.
    The questionnaire will ask how the child's asthma has been during the last week (7 days). Check that the child understands this time frame. If in doubt, ask the parent to identify an event that occurred a week previously (e.g. a football match) and then ask the child to tell you how she/he has been since that event
    Show the child the response card and explain the options. Explain the concept of the 7 responses. Explain that 0 means that they have not had any asthma symptoms at all and that 6 means that their symptoms have been really, really bad. Explain that the other numbers (1–5) represent levels in between. For children who can read, we suggest that you ask them to read aloud each of the responses. For younger children, start by reading to them just the 7 responses to question one (both number and words) and check that they understand the concept (then repeat at the beginning of each question).
    Reassure the child that there are no right or wrong answers.
    • Extract from the ACQ (for children aged 6–10 yrs old). Reproduced with permission from E.F. Juniper. Copyright of the ACQ is held by E.F. Juniper, QOL Technologies Ltd.

  • Table 3– Demographic and baseline data
    Patients35
    Age yrs10.4±2.6
    Sex
     Males21
     Females14
    Medications
     SABA alone3
     SABA + IS13
     SABA + IS + LABA16
     SABA + LABA + Leuk + SC1
     SABA + IS + LABA + Leuk2
    ACQ1.76±0.71
    FEV1 % pred89.4±14.3
    RCP1.85±0.74
    MiniPAQLQ5.09±1.13
    PACQLQ5.23±1.14
    PEF % pred83.1±14.7
    ACD1.30±0.86
    • Data are presented as n or mean±sd. SABA: short-acting β2-agonist; IS: inhaled corticosteroid; LABA: long-acting β2-agonist; Leuk: leukotriene modifier; SC: sodium cromoglycate; FEV1: forced expiratory volume in 1 s; % pred: % predicted; RCP: Royal College of Physicians’ “Three Questions”; MiniPAQLQ: Mini Paediatric Asthma Quality of Life Questionnaire; PACQLQ: Paediatric Asthma Caregiver’s Quality of Life Questionnaire; PEF: peak expiratory flow; ACD: Asthma Control Diary.

  • Table 5– Cross-sectional construct validity#: visit 2
    QuestionnaireMiniPAQLQRCPACDPACQLQ
    ACQ: all questions−0.830.520.77−0.63
    Symptoms alone−0.840.570.71−0.56
    Symptoms plus FEV1 % pred−0.830.520.72−0.61
    Symptoms plus SABA use−0.830.560.77−0.58
    • MiniPAQLQ: Mini Paediatric Asthma Quality of Life Questionnaire; RCP: Royal College of Physicians’ “Three Questions”; ACD: Asthma Control Diary; PACQLQ: Paediatric Asthma Caregiver’s Quality of Life Questionnaire; ACQ: Asthma Control Questionnaire; FEV1: forced expiratory volume in 1 s; % pred: % predicted; SABA: short-acting β2-agonist. #: Pearson correlation coefficients.

  • Table 6– Responsiveness of the Asthma Control Questionnaire (ACQ) and the shortened versions
    QuestionnaireChange in score between clinic visits: stable patients (A)Change in score between clinic visits: unstable patients (B)A versus BResponsiveness index
    Mean±sdp-valueMean±sdp-valueMean±sdp-value
    ACQ all questions−0.20±0.760.29−0.93±1.450.0260.74±1.130.0720.455
    Symptoms alone−0.26±0.900.24−1.24±1.510.0070.98±1.210.0270.544
    Symptoms plus FEV1 % pred−0.28±0.800.16−1.09±1.450.0110.81±1.140.0510.540
    Symptoms plus SABA use−0.17±0.850.42−1.03±1.500.0180.87±1.180.0450.450
    • FEV1: forced expiratory volume in 1 s; % pred: % predicted; SABA: short-acting β2-agonist.

  • Table 7– Longitudinal construct validity#: 1–4 weeks
    QuestionnaireΔMiniPAQLQΔRCPΔACDΔPACQLQGlobal Rating of Change Questionnaire
    ClinicianCaregiver
    ΔACQ all questions−0.890.810.83−0.79−0.72−0.66
    Δsymptoms alone−0.930.810.79−0.84−0.75−0.69
    Δsymptoms plus FEV1 % pred−0.910.810.82−0.80−0.75−0.68
    Δsymptoms plus SABA use−0.910.810.81−0.83−0.71−0.66
    • Δ: change; MiniPAQLQ: Mini Paediatric Asthma Quality of Life Questionnaire; RCP: Royal College of Physicians’ “Three Questions”; ACD: Asthma Control Diary; PACQLQ: Paediatric Asthma Caregiver’s Quality of Life Questionnaire; ACQ: Asthma Control Questionnaire; FEV1: forced expiratory volume in 1 s; % pred: % predicted; SABA: short-acting β2-agonist. #: Pearson correlation coefficients.

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Asthma Control Questionnaire in children: validation, measurement properties, interpretation
E.F. Juniper, K. Gruffydd-Jones, S. Ward, K. Svensson
European Respiratory Journal Dec 2010, 36 (6) 1410-1416; DOI: 10.1183/09031936.00117509

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Asthma Control Questionnaire in children: validation, measurement properties, interpretation
E.F. Juniper, K. Gruffydd-Jones, S. Ward, K. Svensson
European Respiratory Journal Dec 2010, 36 (6) 1410-1416; DOI: 10.1183/09031936.00117509
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