Ana Sá-Sousa

Validation of a questionnaire (CARAT10) to assess rhinitis and asthma in patients with asthma

To cite this article: Fonseca JA, Nogueira‐Silva L, Morais‐Almeida M, Azevedo L, Sa‐Sousa A, Branco‐Ferreira M, Fernandes L, Bousquet J. Validation of a questionnaire (CARAT10) to assess rhinitis and asthma in patients with asthma. Allergy 2010; 65: 1042–1048.

Prevalence of asthma in Portugal - The Portuguese National Asthma Survey

BackgroundAsthma is a frequent chronic respiratory disease in both children and adults. However, few data on asthma prevalence are available in Portugal. The Portuguese National Asthma Survey is the first nationwide study that uses standardized methods. We aimed to estimate the prevalence of current asthma in the Portuguese population and to assess the association between ‘Current asthma’ and comorbidities such as upper airways disease.MethodsA cross-sectional, population-based, telephone interview survey including all municipalities of Portugal was undertaken. Participants were randomly selected to answer a questionnaire based on the Portuguese version of the GA2LEN survey. ‘Current asthma’ was defined as self-reported lifetime asthma and at least one of 3 symptoms in the last 12 months: wheezing, waking with breathlessness or having an asthma attack.ResultsData were obtained for 6 003 respondents, with mean age of 38.9 (95%CI 38.2-39.6) years and 57.3% females. In the Portuguese population, the prevalence of ‘Current asthma’ was 6.8% (95%CI 6.0-7.7) and of ‘Lifetime asthma’ was 10.5% (95%CI 9.5-11.6) Using GA2LEN definition for asthma, our prevalence estimate was 7.8% (95%CI 7.0-8.8). Rhinitis had a strong association with asthma (Adjusted OR 3.87, 95%CI 2.90-5.18) and the association between upper airway diseases and asthma was stronger in patients with both rhinitis and sinusitis (Adjusted OR 13.93, 95%CI 6.60-29.44).ConclusionsCurrent asthma affects 695 000 Portuguese, with a prevalence of 6.8%. People who reported both rhinitis and sinusitis had the highest risk of having asthma.

Control of Allergic Rhinitis and Asthma Test (CARAT) can be used to assess individual patients over time

BackgroundThe Control of Allergic Rhinitis and Asthma Test (CARAT10) has been proposed as the first tool to implement the Allergic Rhinitis and its Impact on Asthma initiative guidelines in clinical practice. To serve this purpose, it must have adequate properties to assess the control of an individual over time. This study aimed to prospectively assess the test-retest reliability, responsiveness and longitudinal validity of CARAT10.MethodsAdults with asthma and allergic rhinitis were enrolled at 4 outpatient clinics of Portuguese central hospitals. At each of the two visits, 4 to 6 weeks apart, patients filled out CARAT10 and additional questionnaires, followed by a medical evaluation blinded to the questionnaires’ answers.ResultsFrom the 62 patients included, 51 patients completely filled out CARAT10 at both visits. The test-retest reliability, computed as an intra-class correlation coefficient, was 0.82. Regarding responsiveness, a significant change (p = 0.002) of CARAT10 score in clinically unstable patients was observed (95%CI -5.08; -1.31) and the Guyatt’s responsiveness index was 1.54. As for the longitudinal validity assessment, the correlation coefficients of the changes of CARAT10 scores with those of ACQ5 and symptoms VAS ranged from 0.49 to 0.65, while with the physician assessment of control they ranged from 0.31 to 0.41.ConclusionCARAT10 has good test-retest reliability, responsiveness and longitudinal validity. It can be used to assess control of allergic rhinitis and asthma, both to compare groups in clinical studies and to evaluate individual patients in clinical practice.

Physical activity in adults with controlled and uncontrolled asthma as compared to healthy adults: a cross-sectional study.

BackgroundThough exercise-induced bronchoconstriction is common among asthmatics, physical activity (PA) seems important in asthma management. Still, various studies point at avoidance of sports and certain daily life activities like walking stairs, even by patients with mild symptoms. We aimed to compare physical activity levels between healthy subjects and asthmatics with controlled and uncontrolled disease.MethodsData on asthma and PA were drawn from the Portuguese National Asthma Survey. The short telephone version of the International Physical Activity Questionnaire (IPAQ) was used to measure PA levels. Current asthma was defined as self-reported asthma and at least one of these criteria: one or more asthma symptoms in the last twelve months, currently taking asthma medication or an asthma medical appointment in the previous twelve months. Controlled asthma was defined as a CARAT global score > 24 or a CARAT second factor score ≤ 16. Healthy subjects were defined as individuals without atopy, heart disease or any respiratory symptom. X2 and Mann–Whitney/Kruskall-Wallis tests were used to compare groups. Logistic regression analyses were performed to assess relations between asthma status and PA dimensions.ResultsA total of 606 non-asthmatics, 125 controlled and 78 uncontrolled asthmatic subjects were included. In both genders, overall PA level did not differ significantly between groups. Controlled (men) and uncontrolled (women) asthmatics did more vigorous PA than healthy respondents. Male controlled asthmatics also did more moderate PA. Crude logistic regression showed positive relations between daily sitting time, vigorous and moderate PA and controlled asthma in men and between vigorous PA and uncontrolled asthma in women. After adjustments for confounders, moderate PA remained a predictor of controlled asthma in men, while vigorous PA doubled the risk of uncontrolled asthma in women.ConclusionOur study showed that adult asthmatics, independent of asthma control, do not seem to have a more sedentary lifestyle than their peers. Nevertheless, PA should be encouraged, as only about half of them reached activity recommendations.

Operational definitions of asthma in recent epidemiological studies are inconsistent

ObjectiveThe best combination of questions to define asthma in epidemiological asthma studies is not known. We summarized the operational definitions of asthma used in prevalence studies and empirically assess how asthma prevalence estimates vary depending on the definition used.MethodsWe searched the Thomson Reuters ISI Web of knowledge and included (1) cross-sectional studies (2) on asthma prevalence (3) conducted in the general population and (4) containing an explicit definition of asthma. The search was limited to the 100 most-cited papers or published since January 2010. For each paper, we recorded the asthma definition used and other variables. Then we applied the definitions to the data of the Portuguese National Asthma survey (INAsma) and of the 2005–2006 National Health and Nutrition Examination Survey (NHANES) computing asthma prevalence estimates for the different definitions.ResultsOf 1738 papers retrieved, 117 were included for analysis. Lifetime asthma, diagnosed asthma and current asthma were defined in 8, 12 and 29 different ways, respectively. By applying definitions of current asthma on INAsma and NHANES data, the prevalence ranged between 5.3%-24.4% and 1.1%-17.2%, respectively.ConclusionsThere is considerable heterogeneity in the definitions of asthma used in epidemiological studies leading to highly variable estimates of asthma prevalence. Studies to inform a standardized operational definition are needed. Meanwhile, we propose a set of questions to be reported when defining asthma in epidemiological studies.

Validation of Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) - a prospective multicenter study

Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) is the first questionnaire that assesses simultaneously allergic rhinitis and asthma control in children. It was recently developed, but redundancy of questions and its psychometric properties were not assessed. This study aimed to (i) establish the final version of the CARATKids questionnaire and (ii) evaluate its reliability, responsiveness, cross‐sectional validity, and longitudinal validity.

Asthma control in children is associated with nasal symptoms, obesity, and health insurance: a nationwide survey.

This study aimed to estimate the prevalence of asthma control and determinants of poor control in the Portuguese pediatric population (<18 years); secondarily, we described asthma‐related healthcare services and medication use.

Asthma control in the Portuguese National Asthma Survey.

INTRODUCTION We aimed (1) to measure asthma control using a structure-questionnaire and patient self-perception of asthma-control in the Portuguese National Asthma Survey (INAsma) and (2) to study the relationship between asthma control and asthma-related quality of life. METHODS We analyze data of asthma patients from a cross-sectional, nationwide telephone interview study - INAsma. Controlled asthma was defined as CARAT global score >24 or CARAT lower airways score ≥16. Mini-AQLQ was used to measure quality of life. RESULTS Two hundred and seven (56.9% [95%CI: 51.8-62.0]) of the 364 patients had controlled asthma. Most patients with non-controlled asthma (88%) perceived their disease as controlled. Patients with controlled asthma presented higher mini-AQLQ scores (median, P25-P75; 6.6, 6.0-6.9) than those with non-controlled asthma (4.9, 3.7-5.7) (p<0.001) and a significant positive correlation between CARAT and mini-AQLQ scores was observed (r=0.706; p<0.001). CONCLUSION More than half of the Portuguese patients presented controlled asthma and showed significantly better asthma-related quality of life. Almost 9 out of 10 patients with non-controlled disease have poor perception of their asthma control, which may hinder them from seeking better asthma control.

Asthma-like symptoms, diagnostic tests, and asthma medication use in children and adolescents: a population-based nationwide survey

Abstract Objective: This study aimed to estimate the prevalence of asthma-like symptoms, current asthma (CA), asthma diagnostic tests, and inhaled medication use in a nationwide pediatric population (<18 years). Methods: Pediatric-specific data from a cross-sectional, population-based telephone survey (INAsma study) in Portugal were analyzed. CA was defined as lifetime asthma and (1) wheezing, (2) waking with breathlessness, or (3) asthma attack in the previous 12 months, and/or (4) taking asthma medication at the time of the interview. Results: In total, 716 children were included. The prevalence of asthma-like symptoms was 39.4% [95% confidence interval (95% CI): 35.7–43.3]. The most common symptoms were waking with cough (30.9%) and wheezing (19.1%). The prevalence of CA was 8.4% (95% CI: 6.6–10.7). Among children with CA, 79.9% and 52.9% reported prior allergy testing and pulmonary function testing (PFT), respectively. Inhaled medication use in the previous 12 months was reported by 67.6% (reliever inhalers, 40.1%; controller inhalers, 41.5%). Those who only used inhaled reliever medications experienced more asthma attacks [odds ratio (OR): 2.69]. Significantly fewer children with CA living in rural areas than those living in urban areas had undergone PFT or used inhaled medication (OR: 0.06 for PFT, 0.20 for medication]. Conclusions: The prevalence of CA in the Portuguese pediatric population was 8.4%. Only half of children with CA had ever undergone PFT; more than half did not use controller inhalers, and those who only used reliever inhalers reported more asthma attacks. These findings suggest that asthma management has been substandard, mainly in rural areas.

Cost of asthma in children: a nationwide, population‐based, cost‐of‐illness study

Childhood asthma is very prevalent and costs can be high, especially in severe disease. This study aimed to estimate the cost of asthma in Portuguese children and the variations by level of asthma control.