Some Simple Scales for Use in Asthma Research

Richards, James M.; Bailey, William C.; Windsor, Richard A.; Martin, Benjamin; Soong, Seng‐Jaw

doi:10.3109/02770908809071376

Cited by 32 publications

(11 citation statements)

References 9 publications

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“…We developed this type of measure to categorize asthma severity in children using health care administrative data. The reliability of our measure, assessed by the test-retest method, was found to be excellent, a rating that was much higher than the findings of internal consistency reported by Richards et al [17] . However, a limitation of the test-retest methodology was the requirement of having asthma prescription records in two consecutive time periods, which was met by only 37% of children.…”

Section: Discussioncontrasting

confidence: 64%

“…The weighted kappa statistic was calculated to describe the percent agreement on the asthma severity categories between the two time periods [25,26] . Psychometric assessments of the reliability of the severity measure, such as the Cronbach alpha coefficient of internal consistency, were not undertaken because the severity algorithm was defined on clinical grounds and consistent correlations between components of the algorithm were not expected [10,17] . For example, the correlation between receipt of inhaled corticosteroids and high bronchodilator use could be positive or negative, depending on the degree of asthma control.…”

Section: Reliability Of the Asthma Severity Measurementioning

confidence: 99%

“…Centered on the stepped care approach to asthma drug therapy and on markers of asthma exacerbation [10][11][12][13][14][15] , drug treatment-based scales assign higher severity scores with successive additions of asthma drugs to the drug therapy regimen and with greater intensity in the use of such drugs [11,[14][15][16][17][18] . Drug treatment-based scales correlate with functional status and physiological measures of asthma severity, and have the advantage of representing severe asthma where intense treatment has resulted in reduction of symptoms [11,[15][16][17][18] ). Critics of treatment-based scales state that drug utilization is not a useful measure of asthma severity because it is influenced by access to medical care and the prescribing patterns of particular physicians [19] .…”

Section: Introductionmentioning

confidence: 99%

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Development of a Drug Treatment-Based Severity Measure in Childhood Asthma

2002

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Valid measures of severity are crucial in asthma pharmacoepidemiological research. This study reports the development and validation of a severity measure in childhood asthma for application to health care administrative data. A drug treatment-based asthma severity measure was developed following the stepped care approach to treatment, and this was applied to a cohort of 16,862 children who met a case definition for asthma drug prescription use between January 1995 and March 1996. Assessments were made of the measure's reliability, validity, and responsiveness to change over time. The drug treatment-based asthma severity measure classified 42% of children as having mild asthma, 37% as having moderate asthma, 19% as having moderate-severe asthma, and 2% as having severe asthma. Agreement on severity classification between two successive time periods was excellent (kappa = 0.82). Children classified as having severe asthma were significantly more likely than children with mild-moderate asthma to have previous asthma hospitalizations, to visit asthma specialists, to have high physician utilization, and to require hospital critical care. They were more likely to be reclassified as having severe asthma 2 years later. These findings show that a drug treatment-based severity measure in childhood asthma, which can be applied to prescription data, has good reliability and validity, and is responsive to changes in asthma severity over time.

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Section: Discussioncontrasting

confidence: 64%

Section: Reliability Of the Asthma Severity Measurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development of a Drug Treatment-Based Severity Measure in Childhood Asthma

2002

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“…Ascertaining asthma severity, however, is not straightforward. Existing indices of chronic asthma severity have relied on multiple dimensions, including symptoms, pulmonary function, and medication use, alone or in various combinations (1,2,(6)(7)(8)(9)(10)(11). These scales are not easily adapted to population-based research when access to detailed clinical information is not available.…”

mentioning

confidence: 99%

Assessment of a Medication-Based Asthma Index for Population Research

Ungar

Santos

2002

Am J Respir Crit Care Med

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Asthma management guidelines recommend the use of preventive medications in sufficient amounts to control asthma symptoms. The validity of a medication use index as a proxy for asthma severity has not been established. We recruited 1,279 Ontario adults with asthma or parents of children with asthma from a community-based surveillance program in 1995-96. Participants completed a telephone questionnaire at baseline, 3 and 6 mo. The questionnaire gathered information about asthma medication use, health care utilization, and symptoms. Asthma was classified as mild in 28%, moderate in 49%, or severe in 23% of patients based on the amount and types of medication used. There were significant differences among groups in health resource use such that adults with higher medication use visited primary care physicians and specialists more frequently, had pulmonary functions tests more frequently, and were admitted to hospital more frequently. The findings among children were similar. There were weak positive correlations between medication use and symptom frequency in adults and children. We conclude that a medication use index may be useful in population-based research where clinical asthma severity data are lacking. Such an index is distinct from but is related to disease control.

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“…Thus, some scores take into account clinical symptoms, whilst others are based mainly on peak flow assessment or measurement of nonspecific bronchial hyperreactivity. Some authors grade asthma in three steps (mild, moderate and severe) [8,12,13], others grade in four [9,14] or five steps [10].…”

mentioning

confidence: 99%

Comparison of an expert system with other clinical scores for the evaluation of severity of asthma

Gautier

Redier²,

Pujol³

et al. 1996

Eur Respir J

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"Asthmaexpert" was produced at the special request of several clinicians in order to obtain a better understanding of the medical decisions taken by clinical experts in the management of asthmatic patients. In order to assess the severity of asthma, a new score called Artificial Intelligence score (AI score), produced by Asthmaexpert, was compared with three other scores (Aas, Hargreave and Brooks).One hundred patients were enrolled prospectively in the study during their first consultation in the out-patient clinic. Distribution of severity level according to the different scores was studied, and the reliability between AI and other scores was evaluated by Kappa and MacNemar tests. Correlations with functional parameters were performed.The AI score assessed higher levels of severity than the other scores (Kappa=18, 28 and 10% for Aas, Hargreave and Brooks, respectively) with significant MacNemar test in all cases. There was a significant correlation between AI score and forced expiratory volume in one second (FEV1) (r=0.73).These data indicate that the AI score is a severity score which defines higher levels of severity than the chosen scores. Correlations for functional parameters are good. This score appears easy to use for the first consultation of an asthmatic patient.

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Some Simple Scales for Use in Asthma Research

Cited by 32 publications

References 9 publications

Development of a Drug Treatment-Based Severity Measure in Childhood Asthma

Development of a Drug Treatment-Based Severity Measure in Childhood Asthma

Assessment of a Medication-Based Asthma Index for Population Research

Comparison of an expert system with other clinical scores for the evaluation of severity of asthma

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