Pediatric Asthma Impairment and Risk Questionnaire: Rationale and Development of a Composite Control Tool

To gain patient and caregiver perspectives on relevant items to include in the development of a Pediatric Asthma Impairment and Risk Questionnaire (AIRQ), assessing asthma control and risk for exacerbation in children.This study included children aged 5 to 11 years with asthma and their caregivers from 1 federally qualified health center and 7 subspeciality practices across the United States.This was a qualitative study using interviews with patients and their parents/caregivers. Patients had to be aged 5 to 11 years with a diagnosis of asthma and a reported use of at least 1 asthma medication within the previous 6 months. In the interview, participants completed the Peds-AIRQ survey, commented on their interpretation of the questions, answered questions about their demographics and exacerbation history over the last year, and completed the Global Initiative for Asthma (GINA) symptom control tool. Physicians of the patients were asked to assess their asthma control. Trained researchers then used the interview transcripts to identify themes and concepts among the participants. The Peds-AIRQ questions were subsequently revised.There were 60 interviews completed with sociodemographically diverse families. Per caregivers’ reports, 53% of children (n = 32) had taken oral corticosteroids (OCS) in the last year, whereas clinicians only reported 33% (n = 15) of children. When assessing asthma control, clinicians classified 80% of children and the GINA symptom control tool classified 53% of children as having well-controlled asthma. However, there were patients in the well-controlled groups that had received OCS in the last year for exacerbation. The majority of children (91%) could describe their asthma symptoms, and most parents reported no difficulty in recounting a 2-week recall for daytime symptoms (83%) or 12-month recall of exacerbations (91%). Most families (97%) felt the Peds-AIRQ would be helpful at health care appointments. Based on dyad feedback, the control tool questions were edited to create a new draft of the Peds-AIRQ.Clinicians and current symptom tools may overestimate control and underestimate burden of symptoms in pediatric patients. This study shows the need for the creation of a comprehensive control tool for pediatric patients aged 5 to 11 years with asthma that engages both children and their caregivers.This study supports that the majority of children in this age group can describe their symptoms and caregiver input is important for accurately assessing the level of asthma control. The creation of a tool with both children and caregiver perspectives may benefit pediatricians caring for children with asthma.