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Comparative Study
. 2019 Jan;122(1):58-64.
doi: 10.1016/j.anai.2018.09.448. Epub 2018 Sep 11.

Comparing Asthma Control Questionnaire (ACQ) and National Asthma Education and Prevention Program (NAEPP) asthma control criteria

Hyekyun Rhee  1 , Tanzy Love  2 , Jennifer Mammen  3
Affiliations
Comparative Study

Comparing Asthma Control Questionnaire (ACQ) and National Asthma Education and Prevention Program (NAEPP) asthma control criteria

Hyekyun Rhee et al. Ann Allergy Asthma Immunol. 2019 Jan.

Abstract

Background: Adequate assessment of control is critical to asthma management. The Asthma Control Questionnaire (ACQ) and the National Asthma Education and Prevention Program (NAEPP) criteria are commonly used measures of asthma control.

Objective: To examine the associations between the ACQ and NAEPP criteria and compare the validity in association with lung function, asthma exacerbation, and quality of life.

Methods: The ACQ and the NAEPP criteria were administered to 373 adolescents with asthma aged 12 to 20 years. The 2 measures correlated with forced expiratory volume in 1 second (FEV1), asthma exacerbation (oral corticosteroid use, hospitalization, and emergency department [ED] use) in the past 12 months, and quality of life.

Results: Agreement between the ACQ and NAEPP criteria was moderate (κ = 0.40-0.61). Neither of the 2 measures was a reliable predictor of FEV1 less than 80% because of the high rate of false-positive results for the ACQ (68%) and low sensitivity for the NAEPP (49%). The NAEPP identified more cases of uncontrolled asthma (84.6%) than the ACQ (64.6%). The ACQ was a significant predictor of recent oral corticosteroid use, hospitalization, and ED visits (area under the curve = 0.66, 0.66, and 0.64, respectively; P < .001), as was NAEPP (area under the curve = 0.63, 0.66, and 0.61, respectively; P < .001). Both measures were significantly associated with quality of life, and the associations were particularly strong for the ACQ (r = -0.87 for symptom subscale, r = -0.76 for activity subscale, and r = -0.78 for emotional function subscale).

Conclusion: Neither the ACQ nor the NAEPP appears to reliably predict lung function, whereas both measures reasonably associate with acute asthma exacerbation. The ACQ may be the superior measure in gauging the psychosocial effect of asthma control given its particularly strong associations with quality of life.

Trial registration: ClinicalTrials.gov Identifier: NCT02293499.

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Conflict of interest statement

Conflict of Interest: none

Figures

Figure 1:
Figure 1:
Proportion of the FEV1<80% for each category of the mean ACQ score (left) and NAEPP total score (right). P-values test for a significant difference in the proportion of FEV1<80% (z-test).
Figure 2:
Figure 2:
ROC curves for predicting FEV1<80% using either the ACQ (solid, AUC = 0.606, p=0.007) or NAEPP (dashed, AUC= 0.605, p=0.003).
Figure 3:
Figure 3:
ROC curves for predicting asthma exacerbation determined by oral corticosteroid (OCS) use (solid line), hospitalization (dashed line), or ED visit (dotted line) using either the ACQ (top panel) or NAEPP criteria (lower panel).
Figure 4:
Figure 4:
Relationships between the Quality of Life symptoms subscale and each of the mean ACQ score (left) and NAEPP total score (right) (N=370).
See this image and copyright information in PMC

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