Comparison of asthma assessment tools to minimize overestimation of control

<bold>Background:</bold> Asthma symptoms and prior exacerbations increase future exacerbation risk. The composite Asthma Impairment and Risk Questionnaire (AIRQ) is superior to impairment-based tools, alone or combined with risk factors, at identifying at-risk patients. <bold>Aims:</bold> To evaluate risk and impairment patterns in patients rated completely/well-controlled (C/WC) by various control tools. <bold>Methods:</bold> 1064 patients ≥12 years were assessed by AIRQ, GINA symptom control questions, Asthma Control Test (ACT), and expert opinion (EO) informed by GINA questions and risk factors. Proportion of patients assessed as C/WC by these methods relative to prior-year exacerbations, prior-two week symptoms (daytime symptoms, night awakening, activity limits, rescue use, social activity limitation, exercise limitations, difficulty controlling asthma), and subsequent exacerbations were compared (McNemar’s test: p≤0.05). <bold>Results:</bold> EO rated the highest proportion of patients as C/WC. Among C/WC patients, AIRQ had the highest proportion without prior exacerbations, a higher proportion without impairment than the two symptom-based tools, and a lower proportion than ACT and EO with prior exacerbations or impairment who had subsequent exacerbations (Figure). For all assessments, both baseline risk and impairment contributed to future exacerbations. <bold>Conclusions:</bold> AIRQ minimizes overestimation of control and best identifies patients needing interventions to prevent exacerbations.