Evaluating Asthma Control: A Comparison of Measures Using an Item Response Theory Approach

Asthma is a common chronic disease, and asthma control is the major therapeutic objective, thus ensuring a good health-related quality of life. This study aimed to evaluate the level of asthma control in a sample of asthmatic patients followed in allergology consultation during our training using the asthma control test (ACT) and its correlation with other parameters. This is a cross-sectional study of 66 asthmatic patients who were followed in pulmonology consultation at Agadir University Hospital after completing the asthma control test questionnaire over 6 months (June to December 2021). The age of the patients ranged from 17 to 76 years, with an average age of 41.36 +/- 13.31 years. There was a predominance of females in this sample, representing 54.5% of the patients against 45.5% of males. All patients were on inhaled corticosteroid therapy (ICS) (as monotherapy in 25.8% of cases and in combination with a long-acting beta-2 mimetic (LABA) in 74.2% of cases). 60.6% of the patients were from low socioeconomic levels, of which 28.8% were from rural areas. 22.7% of the participants were illiterate. Allergic rhinitis was found in 66.6% of patients and allergic conjunctivitis in 45.5%. Active smoking was found in 16.7% of cases. Obesity was found in 10 patients (15.2% of cases). According to the ACT, asthma was totally controlled in 37.9% of cases and partially controlled in 43.9% of patients. The level of asthma control found in this study was lower compared to other populations. The study also showed that better ACT scores and asthma control correlated with higher socioeconomic levels.

BACKGROUND: Despite significant progress in the search for treatable additional features affecting multicomponent control of bronchial asthma, there is currently a paucity of research studies with a comprehensive assessment of the impact of obesity and multimorbidity on quality of life in patients with bronchial asthma. AIM: To assess the effect of personalizing features (obesity and multimorbidity) on the quality of life of patients with different levels of asthma control. MATERIALS AND METHODS: Patients with asthma (n = 237) were divided into 3 groups depending on BMI. Multimorbid pathology was analyzed by Cumulative Illness Rating Scale (CIRS), asthma control — Asthma Control Questionnaire-5 (ACQ-5), quality of life — Asthma Quality of Life Questionnaire with Standardized Activities [AQLQ(S)], anxiety and depression — Hospital Anxiety and Depression Scale (HADS). Statistical analysis: Microsoft Excel, Statistica 12.0, Statgraphics XVIII. RESULTS: Patients with obesity and asthma had more comorbidities (p 0.05). Quality of life in patients with high and normal body weight depended on the level of control and the number of diseases (p 0.05), with getting worse disease control these differences became insignificant. In the group with obesity, activity limitation (p = 0.0150) and overall quality of life (p 0.005) increased significantly with increasing number of diseases. Anxiety levels increased with increasing number of illnesses (p 0.0001). Quality of life of patients according to AQLQ(S) has inverse correlation with BMI (r = −0.5135), age (r = −0.2034) with CIRS scores (r = −0.4905) with anxiety (r = −0.5078) and depression (r = −0.4820) level. CONCLUSIONS: Body weight, level of asthma control, depression and anxiety, and the number of comorbid multimorbid conditions affect the quality of life of patients with asthma. Obesity makes a significant negative contribution to worsening asthma control and patients’ quality of life, in this group patients have the highest level of multimorbidity and they have a prevalence of anxiety. To improve asthma control, patients need a complex examination including assessment of quality of life, depression and anxiety, and comorbidities in order to develop personalization of therapeutic approaches to patient management.

The purpose of this study was to estimate relationships between asthma control and hospital contacts (visits to emergency rooms and hospitalizations) in a group of patients suffering from persistent asthma, after adjustment for prior use of inhaled corticosteroids. A computerized family practice database was used to identify patients (aged 6–50 years) with persistent asthma who received asthma therapy from January 1995. The database provided information on patient demographics and drug therapy. Asthma control was estimated by a survey of patients at the end of a 12-month study period. Frequency of hospital contacts during the study period was related to demographics, asthma control, and prescribed doses of inhaled corticosteroids during a prestudy period. Review of computerized medical files of 497 family practice physicians identified 1966 patients with persistent asthma who met the study criteria. Of these patients, 1251 completed the survey (63.6%). Asthma control was assessed in 1130 patients; it was moderate or poor in 42% of the cases. During the 12-month study period, 14.8% of patients reported at least one hospital contact. The level of asthma control was significantly p < 0.001) associated with hospital contacts. The odds ratio (OR) for hospital contact for good and poor asthma control was 0.5 (95% confidence interval [CI] 0.2–0.7) and 2.2 (95% CI 1.2–4.4), respectively. Asthma control was related to hospital contacts independently of use of inhaled corticosteroids before the study period. Overall, control of asthma was not optimal in this population. The occurrence of hospital contacts was closely related with the level of control. This association was independent of the dose of inhaled corticosteroids prescribed before the study, suggesting that in asthma, hospital contacts are primarily related to the level of control experienced by the patients.

Hypothesis/aims of study. Currently, preeclampsia is one of the most pressing problems of obstetrics due to the complexity of pathogenesis and to the lack of early and reliable diagnostic criteria. The preeclampsia rate in patients with bronchial asthma is proved higher than in asthma free pregnant women. This study aimed to establish the prediction algorithm of preeclampsia development in in pregnant women suffering from bronchial asthma of varying severity and different level of control.&#x0D; Study design, materials and methods. Asthma duration was studied in 110 pregnant women using the SPSS Discriminant Function Analysis method. Basic therapy and level of asthma control were studied together with respiratory tests, obstetrician medical history, and complications of the first and second trimesters of pregnancy. In addition, serum interleukin panel was assessed and placental Doppler measurement was carried out.&#x0D; Results. Clinical and statistical analysis made it possible out of 87 significant risk factors for the development of hypertensive disorders and preeclampsia to form a highly informative set of signs for a linear discriminant model for predicting preeclampsia: 1) asthma exacerbation in the first trimester of pregnancy; 2) asthma duration severity; 3) average dose of inhaled glucocorticosteroid drugs administered to the exact patient during pregnancy; 4) serum levels of tumor necrosis factor, interferon gamma, and interleukins-4, 6, and 8.&#x0D; Conclusion. The inclusion method of step-by-step discriminant analysis allowed establishing a highly informative four-component complex of clinical predictors for preeclampsia development in pregnant women with asthma. The results of the model testing showed its extremely high reliability (up to 100% within study selection as well as within control selection). Thus, the study results can be recommended for clinical use.

Monitoring Asthma Control in Children With Allergies by Soft Computing of Lung Function and Exhaled Nitric Oxide

Tests used for such purposes as determining educational quality, defining educational needs, hiring an employee, student selection and placement and performing guidance and clinic services have an important place in education and psychology. Of course, they should have certain psychometric features related to test scores' validity and reliability. Various test theories have helped to create more valid and reliable measurements and, as a result, to make better decisions regarding individuals. In education and psychology, Classical Test Theory (CTT) and Item Response Theory (IRT) are both widely used. CTT assumes that an individual's observed score is the total of the true score and the error score, while IRT estimates an individual's ability or latent trait from responses to test items (Embretson & Reise, 2000).When IRT assumptions and model-data fit are ensured, item and ability parameters' invariance occurs; this is known as the most important advantage IRT has over CTT. Item and ability parameters' invariance means estimating ability parameters independently of item sample and estimating item parameters independently of ability sample. IRT's invariance feature makes it very practicable in many applications, for instance, test development, computerized adaptive testing, bias studies, test equating and item mapping (Hambleton & Swaminathan, 1985). IRT is classified under two main categories as parametric IRT (PIRT) and nonparametric IRT (NIRT) (Olivares, 2005; Sijtsma & Molenaar, 2002).To analyse ordered items, such as Likert-type attitude items, partial credit cognitive items or not ordered graded items such as multiple-choice test items, item response models are developed towards polytomous items in IRT (Ostini & Nering, 2006). In these models developed for polytomous items, a non-linear relationship between an individual's latent trait and the possibility of choosing a certain category of item answer is explained (Embretson & Reise, 2000). Graded Response Model (GRM), part of IRT models developed for polytomous items, is often preferred by researchers for applications since it is more useful in presentations, portfolios, essays and Likert-type items with ordered item categories (DeMars, 2010; Ostini & Nering, 2006). To scale tests that consist of polytomous items by making true estimates according to GRM, evaluating PIRT's assumptions and model-data fit is necessary. And to provide these assumptions and model-data fit, large samples are needed. At this point, NIRT models draw attention because they provide a practical advantage in determining psychometric properties of tests with fewer items and respondents (Stout, 2001).NIRT models are defined as statistical scaling methods that require fewer assumptions than PIRT models for measuring persons and items (Stochl, 2007). With their wide application area, NIRT models are used in ordinal scales, applied research areas, sociology, marketing research and health research on quality of life (Sijtsma, 2005). The literature reveals that two models, namely, the Mokken model and nonparametric regression estimation models, are employed. These two models are themselves divided into sub-models. The Mokken model consists of the sub-models Monotone Homogeneity Model (MHM) and the Double Monotonicity Model (DMM). Nonparametric regression estimation models consist of such sub-models as the Kernel Smoothing Approach Model (KSAM), the Isotonic Regression Estimation and the Smoothed Isotonic Regression Estimation models (Lee, 2007; Sijtsma & Molenaar, 2002). Along with theoretical studies being conducted, new sub-models are being added to nonparametric regression estimation models.As a NIRT model, MHM requires unidimensionality, local independence and monotonicity assumptions, and it defines the relationship that latent variables and items with homogeneous (unidimensional) and monotone item characteristic curve (ICC) have (Meijer & Baneke, 2004; Sijtsma & Molenaar, 2002). …

BackgroundThe lockdown imposed by the COVID‐19 pandemic resulted in a completely different style of life with possible effects on the attitude toward their disease in patients with chronic lung disease, such as asthma. The aim of our study was to investigate in asthmatic children the level of asthma control and the maintenance therapy used during the lockdown.MethodsAmong asthmatic children attending our clinic, we identified those who had been prescribed the same therapy in March‐April 2019 and March‐April 2020. The level of asthma control (GINA‐score) and the maintenance therapy used during the lockdown (March‐April 2020) were compared with those of March‐April 2019. We separately analyzed a small group of children with severe asthma treated with Omalizumab during the lockdown.ResultsWe enrolled 92 asthmatic children (67 males). Compared to 2019, in 2020 a higher proportion of children modified their maintenance therapy (38% vs. 15.2%, p < .001), with a significant increase in both the proportion of children who increased (p = .033) and in that of children who decreased their therapy (p = .026). The level of control resulted as significantly higher in 2020 (March p = .023; April p = .007). Also, the 13 children treated with Omalizumab showed a good level of control in 2020.ConclusionsIn asthmatic children, the COVID‐19 pandemic lockdown had a significant impact on their asthma control and on their attitude toward maintenance therapy.

Since 2014, the Global Initiative for Asthma (GINA) has stated that asthma control should be measured using four questions concerning diurnal and nocturnal symptoms, activity limitation, and rescue medication use. We assessed how asthma control by this definition correlates with airway inflammation and quality of life.113 asthmatic subjects consecutively recruited from their routine clinical appointment underwent spirometry, sputum induction and answered the Standardised Asthma Quality of Life Questionnaire (AQLQ(S)) during a single visit.43 (38.1%), 37 (32.7%) and 33 (29.2%) subjects had controlled asthma, partly controlled asthma and uncontrolled asthma, respectively. The majority of subjects with controlled asthma (67.4%) had paucigranulocytic sputum. Eosinophilic sputum was present in all levels of asthma control. Although most subjects with controlled asthma (58.1%) achieved an AQLQ(S) score ≥6 (minimal or no impairment), the remaining patients (41.9%) had moderate/some impairment (AQLQ(S) score <6 and ≥3) due to activity impairment and environmental exposure.The present GINA definition of current symptom control reflects control of airway inflammation. However, quality of life impairment can be present even in these patients. Measuring quality of life may provide useful information when evaluating asthma control.

Background: Inhalation has become the preferred route of drug administration compared to oral medication in managing Asthma due to its direct delivery to the airways, thus producing a faster onset of action and fewer systemic side effects at lower doses than would be required for other routes of administration. Aims and Objectives: This study aimed to evaluate the inhaler technique among children with asthma and its association with the level of asthma control and to identify factors associated with improper use of inhaler devices. Materials and Methods: This is a prospective cross-sectional study conducted at the Department of Pediatrics at B. P Koirala Institute of Health Science, university teaching Hospital in Nepal. The children with asthma were asked to use their inhaler device as usual and inhalational technique was assessed using inhaler device assessment tool and control of asthma level was assessed using the Childhood Asthma Control Test score. Results: One hundred and three asthmatic children of the age range of 4–11 years were enrolled in the study. The mean age of surveyed children was 6.3 ± 2.2 years and over half of the participants were boys (68.9%). Around 60% had moderate asthma. Among them, 50% had symptoms for &lt;3 years; only 50% of children with asthma demonstrated good technique of inhaler medication. Forty-five percent of them showed optimal asthma control. Near about a quarter of the participants showed mistakes in one step and about a fifth of the children showed mistakes at more than one step. Almost 30% of children with asthma have not obtained inhaler technique education. Factors associated with poor inhaler technique and poor asthma control were younger age and irregular follow-ups. The most common errors in the proper use of inhalers were not shaking the inhaler before use (30%) and wrong breathing techniques (30%). Conclusions: Improper inhaler technique is common among children with asthma. Children with asthma should have their inhaler technique routinely checked, during visits and should be given detailed education on proper inhalation techniques. Health education programs on asthma control are recommended in countries like Nepal to improve proper asthma inhaler device use and treatment outcomes in children with asthma.

Multiple issues play a role in the effective control of childhood asthma. To identify factors related to the level of asthma control in children receiving asthma care from community pediatricians. Data for 362 children participating in an intervention study to reduce asthma morbidity were collected by a telephone-administered questionnaire. Level of asthma control (well controlled, partially controlled, or poorly controlled) was derived from measures of recent impairment (symptoms, activity limitations, albuterol use) and the number of exacerbations in a 12-month period. Data also included demographic characteristics, asthma-related quality of life, pediatric management practices, and medication usage. Univariable and multivariable analyses were used to identify factors associated with poor asthma control and to explore the relationship between control and use of daily controller medications. Asthma was well controlled for 24% of children, partially controlled for 20%, and poorly controlled for 56%. Medicaid insurance, the presence of another family member with asthma, and maternal employment outside the home were significant univariable factors associated with poor asthma control. Medicaid insurance had an independent association with poor control. Seventy-six percent of children were reported by parents as receiving a daily controller medication. Comparison of guideline recommended controller medication with current level of asthma control indicated that a higher step level of medication would have been appropriate for 74% of these children. Significantly lower overall quality-of-life scores were observed in both parents and children with poor control. Despite substantial use of daily controller medication, children with asthma continue to experience poorly controlled asthma and reduced quality of life. Although Medicaid insurance and aspects of family structure are significant factors associated with poorly controlled asthma, attention to medication use and quality-of-life indicators may further reduce morbidity.

Objective To investigate the value of the first 3 items of asthma control test (ACT-3)for evaluating level of asthma control.Methods ACT were administered to 102 asthma patients from Nanfang Hospital.Spirometry was also used.Uncontrolled asthma was defined as ACT≤19,and well controlled asthma was defined as ACT≥20.The correlation analysis between ACT,ACT-3 and the lung funcion indexes were conducted,respectively.The property of ACT-3 for identifying the uncontrolled asthma was evaluated using receiver operator characteristic (ROC) curve. And then,the agreement between ACT-3 and ACT for identifying the uncontrolled asthma was determined using kappa coefficient.Results The coefficient of correlation between the ACT-3 and ACT was 0.919 (P=0.000).Statistically significant positive correlation were observed between the ACT-3,ACT and lung funcion indexes such as forced expiratory volume in one second (FEV1),percent predicted of FEV1,respectively.The areas under the ROC curve of ACT-3 for identifying the uncontrolled asthma was 0.974 (P =0.000).The optimal cutoff level of ACT-3 to discriminate between uncontrolled and well controlled asthma was 11 scores,giving 94.52％ sensitivity and 93.10％ specificity,respectively.Kappa coefficient showed a strong agreement between ACT-3 and ACT (kappa =0.858,P =0.000).Conclusions The ACT-3 is able to assess the level of asthma control,and there's a strong agreement between ACT-3≤11 and ACT≤19 for identifying the uncontrolled asthma.ACT-3 may be a good choice when the full ACT is not available. Key words: Asthma; Asthma control test; Consistency

BackgroundIn medical education research, various questionnaires are often used to study possible relationships between strategies and approaches to teaching and learning and the outcome of these. However, judging the applicability of such questionnaires or the interpretation of the results is not trivial.MethodsAs a way to develop teacher thinking, teaching strategy profiles were calculated for teachers in a research intensive department at Karolinska Institutet. This study compares the sum score, that was inherent in the questionnaire used, with an Item Response Theory (IRT) approach. Three teaching dimensions were investigated and the intended sum scores were investigated by IRT analysis.ResultsAgreements as well as important differences were found. The use of the sum score seemed to agree reasonably with an IRT approach for two of the dimensions, while the third dimension could not be identified neither by a the sum score, nor by an IRT approach, as the items included showed conflicting messages.ConclusionsThis study emphasizes the possibilities to gain better insight and more relevant interpretation of a questionnaire by use of IRT. A sum score approach should not be taken for granted. Its use has to be thoroughly evaluated.

Introduction of new asthma guidelines did not improve asthma control in a Dutch paediatric population

To test, modify and validate a set of illustrations depicting different levels of asthma control and common asthma triggers in pediatric patients (and⁄or their parents) with chronic asthma who presented to the emergency department at the Children's Hospital of Eastern Ontario, Ottawa, Ontario. Semistructured interviews using guessability and translucency questionnaires tested the comprehensibility of 15 illustrations depicting different levels of asthma control and common asthma triggers in children 10 to 17 years of age, and parents of children one to nine years of age who presented to the emergency department. Illustrations with an overall guessability score <80% and⁄or translucency median score <6, were reviewed by the study team and modified by the study's graphic designer. Modifications were made based on key concepts identified by study participants. A total of 80 patients were interviewed. Seven of the original 15 illustrations (47%) required modifications to obtain the prespecified guessability and translucency goals. The authors successfully developed, modified and validated a set of 15 illustrations representing different levels of asthma control and common asthma triggers. These illustrations will be incorporated into a child-friendly asthma action plan that enables the child to be involved in his or her asthma self-management care.

Data-driven item selection for the Shirts and Shoes Test