Asthma and lower airway disease
The Pediatric Asthma Control and Communication Instrument asthma questionnaire: For use in diverse children of all ages

https://doi.org/10.1016/j.jaci.2013.01.007Get rights and content

Background

National Institutes of Health asthma guidelines recommend questionnaires to assess asthma control, but these questionnaires are not useable across the entire pediatric age spectrum and have not been validated among significant numbers of minority or Spanish-speaking children.

Objective

We sought to evaluate a questionnaire designed to assess asthma control across a broad age range of minority and Spanish-speaking children cared for in an outpatient setting.

Methods

Between July 1, 2007, and September 30, 2010, we collected information using the Pediatric Asthma Control and Communication Instrument (PACCI), the Asthma Control Test (ACT; or the childhood ACT for children 4-11 years old), the Pediatric Asthma Caregiver Quality of Life Questionnaire, and lung function and clinicians' ratings of asthma status among a population of children presenting for routine asthma specialist care. The PACCI measure of asthma control was validated by evaluating accuracy, internal reliability, and concurrent, discriminative, and known-groups validity.

Results

We collected information on 265 English- and 52 Spanish-speaking children (mean age, 8.2 years; 58% male; 44% African American). Across all age groups and in both languages, PACCI control showed good internal reliability and strong concurrent, discriminative, and known-groups validity with ACT and Pediatric Asthma Caregiver Quality of Life Questionnaire scores and clinicians' ratings of asthma control. The accuracy of the PACCI in classifying children with uncontrolled asthma was good (area under the curve, 0.83; 95% CI, 0.79-0.88).

Conclusions

The PACCI accurately measures asthma control in English- and Spanish-speaking children. The PACCI should be useful to clinicians to assess and classify asthma according to National Institutes of Health asthma guidelines.

Section snippets

Questionnaire development and content

The PACCI was developed in conjunction with the adult Asthma Control Communication Instrument (ACCI).21 Both asthma assessment tools are written at a fifth-grade reading level, were designed for use across diverse patient populations, and are intended to help clinicians better use patient/parent-reported information to guide asthma treatment.

The conceptual domains incorporated into the PACCI were derived from a variety of patient and physician focus groups,21, 22 including inner-city, African

Results

There were a total of 265 English-speaking and 52 Spanish-speaking participants. Seventy-nine percent of the English-speaking subjects were recruited from JHCC, whereas all of the Spanish-speaking participants were recruited from SFGH. Table I provides an overview of the participants. A higher percentage of boys and a lower percentage of African Americans were observed among patients less than 5 years of age (P < .01 for both comparisons). Parental education levels were quite varied. Compared

Discussion

The present study demonstrates that the PACCI is a valid measure of control in pediatric patients with self-reported doctor-defined asthma who are treated at an asthma clinic. Specifically, the PACCI (1) effectively measures asthma control status in children, (2) distinguishes clinically important differences of disease status, (3) accurately categorizes patients with controlled or uncontrolled asthma compared with the clinician's assessment, (4) can be used in children of different ages and

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    Supported by National Heart, Lung, and Blood Institute grant HL089410.

    Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

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