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Assessment of the Severity of Asthma in a Family Practice
Authors:Narendrakumar Venilal Morris   Michael John Abramson  Malcolm John Rosier  Roger Peter Strasser
Affiliation: a Park Orclands Medical Centre, Park Orchards, Victoria, Australiab Department of Community Medicine and General Practice, East Bentlcigh, Victoria, Australiac Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, Victoria, Australiad Centrefor Rural Health Monash University, MOE, Victoria, Australia
Abstract:The objective of this study was to evaluate clinical history and self-perception of severity as predictors of asthma severity. A short-term longitudinal study was conducted in a family practice in Melbourne, Australia, utilizing peak flow monitoring, medication diary, and self-administered asthma severity questionnaire. Seventy-two asthmatic subjects with a positive bronchodilator or exercise test, aged between 6 and 79 years, were studied. Symptom and treatment items were correlated with peak flow variability and minimal peak expiratory flow rate (PEFR). An asthma severity scale was generated using the partial credit version of Item Response Theory and the participants' severity scores were validated against lung function tests and medication usage. Quantitative modeling procedures were used to investigate the interrelationships of factors associated with peak flow variability. Severity scores demonstrated significant relationships with peak flow variability (partial r = 0.34) and treatment items. Self-perceived severity of asthma in the preceding 2 weeks showed significant association with peak flow variability (partial rho = 0.46) and minimal PEFR (rho = -0.41). The severity module of the Monash Respiratory Questionnaire is a valid and reliable instrument. The most important symptoms appear to be the frequency of use of bronchodilator and frequency of nocturnal attacks. A carefully structured clinical history in conjunction with the peak flow criteria of variability and minimal peak flow rate would be appropriate in the evaluation of asthma severity. Patients' self-perception of the severity of their asthma needs further evaluation.
Keywords:Asthma  Severity  Self-perception  Questionnaires and item response analyses
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