Advancing assessment of asthma control with a composite tool: the Asthma Impairment and Risk Questionnaire

Background National and international asthma guidelines and reports do not include control tools that combine impairment assessment with exacerbation history in one instrument. Objective To analyze performance of the composite Asthma Impairment and Risk Questionnaire (AIRQ®) in assessing both domains of control and predicting exacerbation risk compared to Global Initiative for Asthma's 4-question symptom control tool (GINA SCT), Asthma Control Test (ACTTM), and physician expert opinion (EO) informed by GINA SCT responses and appraisal of GINA-identified risk factors for poor asthma outcomes. Methods Multivariable logistic regressions evaluated AIRQ and GINA SCT as predictors of ACT. McNemar's test compared the proportion of patients categorized at baseline as completely or well-controlled by each assessment but with current impairment or prior- and subsequent-year exacerbations. Results The analysis included 1064 patients aged ≥12 years; mean(SD) age 43.8(19.3) years; 70% female; 79% White; 6% Hispanic or Latino. AIRQ and GINA SCT were highly predictive of ACT well-controlled versus not well- and very poorly controlled (ROC AUC AIRQ=0.90, GINA SCT=0.86, P=0.03 AIRQ vs GINA SCT) and ACT very poorly controlled versus well- and not well-controlled asthma (ROC AUC AIRQ=0.91, GINA SCT=0.87, P=0.01 AIRQ vs GINA SCT). AIRQ rated fewer patients as completely or well-controlled who had current impairment (P<0.01) or with prior- and subsequent-year exacerbations (P<0.001) compared with GINA SCT, ACT, and EO. Conclusion Relative to other control tools and EO informed by GINA SCT and risk factors for poor asthma outcomes, AIRQ performs better in assessing both domains of current control and predicting exacerbation risk.