Lotte van Den Nieuwenhof

Airway hyperresponsiveness (AHR) is a characteristic feature of asthma, but it is unclear whether asymptomatic AHR is associated with a higher risk of asthma. The present study assessed whether there is an association between asymptomatic AHR in adolescence and asthma in adulthood. The association between allergy and development of asthma was also investigated.A follow-up study of a general population cohort of adolescents was performed 14 yrs after baseline. Respiratory status was assessed at baseline in 1989 and at follow-up in 2003–2004 by a respiratory symptoms questionnaire, spirometry and histamine challenge. Allergy status was also assessed.The respiratory status of 199 subjects was assessed twice. In total, 91 (46%) subjects had the same AHR status in combination with respiratory symptoms at follow-up as at baseline. Adjusted for age, sex, allergy, family history of asthma and smoking history, having asymptomatic AHR was not significantly related to having asthma 14 yrs later (odds ratio (OR) 2.15, 95% confidence interval (CI) 0.67–6.83). For subjects with allergy at baseline, the OR for developing asthma was 4.45 (95% CI 1.46–13.54).Screening for asymptomatic airway hyperresponsiveness in adolescence does not identify subjects at risk of developing asthma. Conversely, the presence of allergy in adolescence does seem to be a risk factor for asthma development.

PURPOSE: A substantial proportion of adult patients with asthma have inadequately controlled symptoms despite the availability of effective treatment. The Asthma Control Questionnaire (ACQ) can be used to discriminate between asthma patients with well- and suboptimally controlled asthma symptoms. The objective of this study was to investigate whether a postal mailing of the ACQ can be used to identify asthma patients with suboptimal symptom control in family practice. METHODS: In this observational study, we sent 434 asthma patients from 6 Dutch family practices an ACQ by mail to measure control of their asthma symptoms. Both respondents and nonrespondents were characterized by information gathered from their medical records. Patients with an ACQ sum score (total score) of greater than 3 were considered to have suboptimally controlled asthma symptoms. RESULTS: The response rate was 77%. Respondents were more likely than non-respondents to be female and to use asthma medication. The mean ACQ sum score of the respondents was 5.2. Of this group, 53.4% (95% confidence interval, 48.0%-58.8%) had suboptimally controlled asthma symptoms. Of the 168 respondents who had not visited their family physician in the 2 years before the study, 42.9% (95% confidence interval, 35.4%-50.4%) had inadequate asthma symptom control. CONCLUSIONS: Our results show that a postal mailing of the ACQ is an effective approach for tracing asthma patients who need medical attention. It also traces patients who would otherwise not have consulted their family physician. The ACQ seems to be a useful starting point for health care professionals in family practice to improve the level of asthma symptom control in their patient populatio

Background. A substantial number of adult patients with asthma are inadequately controlled despite the availability of effective asthma treatment. Patients and physicians seem to overestimate the level of asthma control. Objective. The current study explores whether valid differentiation is possible between asthma patients with controlled and uncontrolled asthma symptoms, on the basis of the Asthma Control Questionnaire (ACQ). Methods. In this multi-centre, cross-sectional study, patients were classified according to Global Initiative for Asthma criteria into levels of asthma symptom control based on a diary card registration. We defined Step 1 (‘well controlled’ asthma symptoms), Step 2 (‘moderately controlled’), Step 3 (‘poorly controlled’) and Step 4 (‘very poorly controlled’). These control steps were related with the sum score of the ACQ. Results. From 108 asthma patients complete data were obtained. The Step 1 subgroup comprised 17 patients; Step 2, 12 patients; Step 3, 22 patients; and Step 4, 57 patients. Receiver Operating Characteristic curve analysis showed that the optimal ACQ sum score cut-off value to differentiate between Step 1 and Steps 2, 3 and 4 was three points (sensitivity: 84%, specificity: 76%). For Steps 1 and 2 versus Steps 3 and 4, this was four points (sensitivity: 77%, specificity: 59%). For Steps 1, 2 and 3 versus Step 4, this was six points (sensitivity: 70%, specificity: 74%). Conclusion. Our results show that discrimination between asthma patients with controlled and uncontrolled asthma symptoms, based on the ACQ, is possible with a reasonable margin of test inaccuracy. Thus, the ACQ may be an important tool for health care professionals who aim to optimize the level of asthma control in their patient population.

BACKGROUND We examined the natural history of asthma in a primary care cohort of patients 10 years after the cohort was stratified for asthma risk by responses to a questionnaire and bronchial hyperresponsiveness (BHR) testing.