The IPCRG Users’ Guide to currently available asthma control tools

In February 2006 the IPCRG held an international meeting to discuss the value of measuring asthma control. One of the outputs will be a paper intended for a peer-reviewed publication.  In addition we asked the users of these tools to help us produce some practical information for primary care practitioners about the use of asthma control tools to support patient consultations, not clinical research.

How should you select a measurement tool?

There are a number of criteria to consider, which are dependent upon your context: country, culture, the time you have with your patient, your relationship with your patient, the availability of technology, and so on.  The table [link] includes 6 criteria that the IPCRG users of such tools thought important.  They assessed a number of currently available tools against these criteria to give you a guide to which might suit your needs.

Fully validated: does it have face and content validity, and has it been validated for use in all ages; is it responsive? Clinically meaningful: would the result of the test give you sufficient information to help you make a clinical decision? Practical for use in consultations: could you use it in a standard primary care consultation? Flexible administration: can it be self-completed on paper, or electronically, or used by post or by telephone? Suitable for a range of patients: can it be used by children and adults with a range of literacy levels? Suitable for a range of nationalities: has it been translated into a range of languages and validated in those languages?  Has allowance been made for cultural differences?

We did not weight these criteria, but you may choose to do this.  You may choose to omit some if they do not apply.

What we looked at

The tools we discussed are widely available and used in a number of countries.  We expect that there are more, and know that others are in development, and would be delighted to hear from you about these.  If you need hard copies of these tools you may need to find a local source.  Some of the pharmaceutical companies may have access to hard copies if you approach them.

Bear in mind that some of these tools were designed with different purposes, for example some were originally designed as a research tool.  However, we assessed all of them for use in a typical primary care consultation lasting no more than 10 minutes. 

Our conclusions

Trade-offs

None of them capture everything that you would want. All have strengths, but you will have to trade off speed with a full exploration of the patient’s condition.

Complementary tools
This table includes tools that measure control.  However, we are aware that important outcomes would be missed if that is all that is measured. For example, someone may be symptom free but have had several exacerbations in the last year.  A fuller assessment of a patient’s asthma status could involve methacholine challenge; sputum cell counts or exhaled nitric oxide measurement (ENO), tools that are not readily available or currently used in clinical practice.

In short, ideally we need tools that measure what we would want to measure in 5 years time.  What we have are tools that measure what we wanted 5 years ago.  The tools lag behind the research.

Nor do the tools help you enquire or understand about the cause of your patient’s asthma status.  For that, the IPCRG would recommend other tools, such as the Minimal Asthma Assessment Tool ¹(MAAT) that includes a wider range of measures including exacerbations.

Patient goals

Identifying level of control and the reasons for it does not produce a management plan.  So, the group also discussed setting individual patient goals, and careful consideration of the questions used during a consultation, since these frame the responses.  We considered questions such as

• What do you want?
• How is your asthma doing?
• What do you want to be better?
• What's better now?
  

The group considered the value of setting personal goals with patients phrased as actions – “I want to be able to do x…” This then sets a specific and personal baseline that the practitioner and the patient can use to monitor improvement.

What next?

 
What do you think?  Do you know of other tools?  Do you want to help us develop this further?  If so, please contact sam.knowles@abdn.ac.uk.

 
June 2006

 ¹MAAT