Assessing asthma control in routine clinical practice: use of the Royal College of Physicians ‘3 Questions’

Abstract

Aims: To evaluate the Royal College of Physicians (RCP) '3 questions' in the assessment of asthma control.Methods: This was a prospective observational study. Subjects (20 adults and 15 children) were assessed 2-weekly over 12 weeks, with data collection on RCP scores (yes/no for each question, 0-3), lung function, asthma control questionnaire (ACQ), asthma quality of life questionnaires (AQLQ), bronchodilator use, and exhaled nitric oxide level.Results: Between-subject analysis showed that the RCP score correlated strongly with the ACQ (correlation coefficient 0.79, p<0.001), AQLQ (-0.71, p=0.001) and bronchodilator use (0.52, p=0.02) in adults, although in children the correlations were weaker and nonsignificant. Within-subject analysis showed strong correlations between changes in the RCP score and ACQ score in adults (0.67, p<0.001) and children (0.61, p<0.001), between quality of life scores in adults (-0.67, p<0.001) and children (-0.69, p<0.001), and changes in bronchodilator use in adults (0.49, p<0.001) and children (0.48, p<0.001). Weaker or absent correlations existed with lung function and no correlations with exhaled nitric oxide levels. An RCP score of 1 or more identified 89% of occasions when the ACQ was >1.Conclusions: The RCP 3 questions reliably quantify current asthma control in this dataset, with a negative response to all 3 questions indicating good control. These data support the use of the 3 questions, but larger validation studies are needed.

Clinical implications of the Royal College of Physicians three questions in routine asthma care: a real-life validation study

“…19 we observed similar sensitivity (RCP3Q extracted from the routine records detected 96% of patients with ACQ >1 compared with 94%) but specificity was halved (34% compared with 67%). This may reflect the explicit 1-week timescale applied in the research context compared with a relatively open-ended approach used to assess control in real life which would be more likely to capture a recent episode of poor control.…”

“…18 When administered formally within a battery of questionnaires in a prospective observational study of 20 adults assessed 2-weekly for 12 weeks, there was a highly significant correlation between the RCP3Q and the ACQ (0.79, p<0.001) and a strong relationship between changes in both the scores. 19 In the UK, annual recording of the RCP3Q has been introduced as an essential component of an annual asthma review within the QOF. 6 This multicentre study aimed to investigate the performance of the RCP3Qs in a real-life practice setting compared with the gold standard of the ACQ administered by self-completed questionnaire, and to examine the additional predictive value of other contextual data.…”

Uniform definition of asthma severity, control, and exacerbations: Document presented for the World Health Organization Consultation on Severe Asthma

“…These tools score asthma indices as continuous variables and thus provide numeric values to distinguish different levels of control (eg, Asthma Control Test, 53 Childhood Asthma Control Test, Asthma Control Questionnaire, 54 Asthma Therapy Assessment Questionnaire, 55 Royal College of Physicians Questionnaire, 56 Asthma Control Scoring System 57 ). Most of these instruments do not include a measure of lung function.…”

Leukotriene Antagonists as First-Line or Add-On Asthma-Controller Therapy

“…25, 26 Secondary outcome measures included the ACQ score 27 ; the score on the not-yet-validated Royal College of Physicians 3-item asthma questionnaire (RCP3) (range of scores, 0 to 3, with higher scores indicating worse asthma control) 30 ; the score on the validated 14-item Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) (range of scores, 0 to 6, with higher scores indicating worse rhinitis-related impairment and with an MID of 0.7) 31 ; and the frequency of asthma exacerbations, which were defined as the need for an oral course of glucocorticoids or hospitalization for asthma.…”