Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 6

Table 1. Assessing asthma control and adjusting therapy in youths ≥12 years of age and adults*
Classification of asthma control (≥12 years of age)
Components of control

Well controlled

Not well controlled

Very poorly controlled

≤2 days/week but not more
than once on each day

>2 days/week or multiple times
on ≤2 days/week

Throughout the day

Nighttime awakenings

≤1x/month

≥2x/month

≥2x/week

Interference with normal activity

None

Some limitation

Extremely limited

>2 days/week

Several times per day

>80% predicted/personal best
>80%

60−80% predicted/personal best
75−80%

<60% predicted/personal best
<75%

Exacerbations requiring oral systemic
corticosteroids

0−1/year

≥2/year (see note)

Reduction in lung growth

Evaluation requires long-term followup.

Treatment-related adverse effects

Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of
intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk.

Impairment Symptoms

Short-acting beta2-agonist use for
≤2 days/week
symptom control (not prevention of EIB)
Lung function
• FEV1 or peak flow
• FEV1/FVC
Risk

Consider severity and interval since last exacerbation

*Reprinted from Expert Panel Report 3 (1).
EIB indicates exercise-induced bronchospasm; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity.
Notes:
• The level of control is based on the most severe impairment or risk category. Assess impairment domain by patient’s/caregiver’s recall of previous 2–4 weeks and by
spirometry or peak flow measures. Symptom assessment for longer periods should reflect a global assessment, such as inquiring whether the patient’s asthma is better or
worse since the last visit.
• At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma control. In general, more frequent and intense exacerbations
(e.g., requiring urgent, unscheduled care, hospitalization, or intensive care unit admission) indicate poorer disease control. For treatment purposes, patients who had ≥2
exacerbations requiring oral systemic corticosteroids in the past year may be considered the same as patients who have not-well-controlled asthma, even in the absence of
impairment levels consistent with not-well-controlled asthma.

medications, excluding those with known chronic obstructive pulmonary disease, pulmonary fibrosis, or other complicating lung disease. Patients with diagnosed asthma were
randomized in a 1:1 fashion to complete either Ro2 or ACT.
These self-reported tests were completed before assessment by
certified asthma educators, who used a template taken directly
from the EPR-3 guidelines to determine asthma control and
had no prior knowledge of patient responses to either Ro2 or
ACT. Not-well-controlled asthma was defined by the Ro2 as

any positive response to the four-item questionnaire and by
the ACT as a score of ≤19. The degree of agreement (kappa)
between the more comprehensive EPR-3 template and Ro2
or ACT, in addition to patient self-perception of control, was
calculated (7). A power analysis determined that a sample
size of 150 was needed to detect a true kappa value of 0.70
based on a significance level of 0.05. This study was approved
by the Baylor Health Care System institutional review board
(IRB #009-084).

Please check the proper box. Thank you.
Do you have asthma symptoms or use your quick relief inhaler more
than two times per week?

Yes ___ No ___

Do you awaken at night with asthma symptoms more than two
times per month?

Yes ___ No ___

Do you refill a canister of quick relief medication more than two
times per year?

Yes ___ No ___

When you have asthma symptoms, does your peak flow
vary more than two times 10 (20%) from baseline?

Y e s __ _ N o _ __ I d o n ’ t k no w_ _ _

Figure 1. Rules of Two patient asthma questionnaire.
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Baylor University Medical Center Proceedings

RESULTS
Of the 150 patients who participated in this study, 130 were
surveyed at the Baylor Martha
Foster Lung Care Center, an outpatient facility that is a part of Baylor
Unive '6