Monitoring Asthma Control

DR. SOPHOCLES: How does one monitor asthma control?
DR. COX: This slide is how you would assess control in a child 0-4 and really, it takes the questions that I just asked and gives you some of the answers, and how those would stratify the patient based on thoseanswers. If they are waking up more than once a month and they have some limitations to normal activity, they are considered “not well controlled.” They are “well controlled” if they have symptoms less than twice a week, they wake up one time a month or less, they have no interference with normal activity, and they are using their rescue med less than two times a week. That would be “well controlled.”

There’s a similar table for children age 5-11 with similar parameters. With the exception that we now include lung function measurement in the “well controlled,” “not well controlled” and “poorly controlled” groups, with greater than 80% considered “well controlled” and that’s a personal best. Fifty percent to 80% is “not well controlled” and then less than 50% of predicted or personal best is considered “poorly controlled” in children 5-11.

The adult Evaluation of Control Table is similar, but what is added to this particular table is a table for a validated questionnaire. One of the recommendations in the guidelines is that we use one of the validated questionnaires for asthma control on our follow-up visits with patients. These are called the ACT, the ACQ, or the ATAQ test, and you can go to the website and download these. This table gives you the scores of each of these tests that would place them in the different categories. The ACT test is a simple five-question test and a score of less than 15 would put the patient in “very poorly controlled.” “Not well controlled” would be 15 to 19, and greater than 20 would be “well controlled.” With the ACQ less than 0.75 would be “well controlled,” greater than 1.5 would be “not well controlled,” and they don’t have a score for very poorly controlled. For the ATAQ, a score of zero is “well controlled,” a score of one to two is “not well controlled,” and a score of three to four is “poorly controlled.”

One of the strongest emphases in this document is education. Asthma education begins at diagnosis, occurs at all points of care, and involves all members of the healthcare team. It includes developing goals for treatment, a written asthma action plan with selfmonitoring recommendations, environmental control measures, pharmacotherapy and that should include teaching the patient what the medications are for, how they are used, the side effects, what they can expect in terms of benefit, and regular assessment of proper technique and adherence to medication regimen. And very important is assessing proper inhaler technique.