Health care education, delivery, and quality
Quantifying asthma symptoms in adults: The Lara Asthma Symptom Scale

https://doi.org/10.1016/j.jaci.2007.09.025Get rights and content

Background

Accurate assessment of asthma symptoms is critical in research and clinical settings. A multidimensional asthma control questionnaire could provide more accurate information about asthma symptoms than global assessments, which often overestimate asthma control.

Objective

We sought to evaluate the efficacy of the Lara Asthma Symptom Scale (LASS) in adults with persistent asthma.

Methods

Participants were 18 to 64 years of age with persistent asthma. Data were collected at baseline, 6 months, and 12 months. We described the construct and predictive validity of the LASS by comparing it with measures of pulmonary function (FEV1), asthma-specific quality of life (Juniper's Asthma Quality of Life Questionnaire [AQLQ]), and health care use (emergency department [ED] visits and hospitalizations).

Results

Three hundred eighty-three participants provided baseline data. The LASS had high internal consistency reliability (Cronbach α = .84). LASS scores correlated significantly with baseline measures of FEV1 (−0.20, P = .0002), AQLQ (−0.68, P < .0001), ED visits (0.17, P = .002), and hospitalizations (0.15, P = .008). Baseline LASS scores were associated significantly with ED visits (P = .03) and hospitalizations (P = .04) over the subsequent 12 months. Change in LASS scores over time correlated significantly with changes in FEV1 (−0.22, P = .001) and AQLQ (−0.70, P < .001).

Conclusions

The LASS demonstrated good internal consistency, excellent validity based on concurrent criterion validity and longitudinal predictive validity, and good discriminatory properties in a heterogeneous sample of adults with persistent asthma.

Clinical implications

This study validates a simple multidimensional asthma questionnaire as a clinical tool in the assessment of asthma control in adults.

Section snippets

Participants

Data for this study were obtained from the baseline and follow-up evaluations of adult participants in the South Texas Asthma Management Project, a large, single-center, prospective, randomized controlled trial of disease management interventions to improve clinical asthma outcomes.13 The institutional review boards of all participating institutions approved this study. All participants signed a written informed consent form. Adult participants were between 18 and 64 years of age with a

Results

We enrolled 429 adults, of whom 383 (89%) spoke English as their primary language. Three hundred seventy-five had complete LASS data at baseline and verified asthma health care use data (n = 224 had valid questionnaire data at both baseline and 12 months). At baseline, subjects who failed to complete the 12-month questionnaires were similar to completers in symptom score, severity, health care use, quality of life, and most demographic variables. Noncompleters were younger (mean age, 39 vs 45

Discussion

The LASS demonstrated good internal consistency, excellent validity based on concurrent criterion validity and longitudinal predictive validity, and good discriminatory properties in a heterogeneous sample of adults with persistent asthma. The internal consistency reliability (Cronbach α = .84) was in the same range as previously reported values for another validated questionnaire, the ACT (0.79-0.85).6, 23 Our findings of strong correlations with other measures of asthma health status are

References (34)

  • M. Schatz et al.

    Reliability and predictive validity of the Asthma Control Test administered by telephone calls using speech recognition technology

    J Allergy Clin Immunol

    (2007)
  • H. Pinnock et al.

    Concordance between supervised and postal administration of the Mini Asthma Quality of Life Questionnaire (Mini AQLQ) and Asthma Control Questionnaire (ACQ) was very high

    J Clin Epidemiol

    (2005)
  • M. Schatz et al.

    Relationships among quality of life, severity, and control measures in asthma: an evaluation using factor analysis

    J Allergy Clin Immunol

    (2005)
  • J.K. Schmier et al.

    The impact of inadequately controlled asthma in urban children on quality of life and productivity

    Ann Allergy Asthma Immunol

    (2007)
  • Global Initiative for Asthma (GINA). GINA report: global strategy for asthma management and prevention; 2006. Available...
  • Centers for Disease Control and Prevention (CDC)

    Asthma prevalence and control characteristics by race/ethnicity—United States, 2002

    MMWR Morb Mortal Wkly Rep

    (2004)
  • A.L. Fuhlbrigge et al.

    The burden of asthma in the United States. Level and distribution are dependent on interpretation of the National Asthma Education and Prevention Program Guidelines

    Am J Respir Crit Care Med

    (2002)
  • Cited by (25)

    • Researching asthma across the ages: Insights from the National Heart, Lung, and Blood Institute's Asthma Network

      2014, Journal of Allergy and Clinical Immunology
      Citation Excerpt :

      National Asthma Education and Prevention Program guidelines highlight asthma control as a major goal of therapy, and a patient’s level of asthma control is a key factor in guidelines for how clinicians should modify their management of the disease.34 Ideally, in cross-age studies it would be most efficient and simplest to use an instrument that has been developed for patients of all ages (eg, Royal College of Physicians Three Questions35 and Lara Asthma Symptom Scale36); however, there is limited information on the validity, reliability, and diversity of populations tested for these instruments. The Asthma Control Questionnaire and Asthma Control Test (ACT) are commonly used instruments to assess asthma control; however, they are only applicable to older children.

    • Asthma control measurement using five different questionnaires: A prospective study

      2013, Respiratory Medicine
      Citation Excerpt :

      Whether these scores are categorical or continuous, predicted values have been proposed to define two or three levels of control. Although several scores have been published [2–10], they differ by the factors that were considered and the weight that was given to each item [1]. They are mainly used according to local preference for the everyday management of asthma but are also the pillar of asthma assessment in many studies on asthma treatment or monitoring modalities.

    • Quality of life, health care utilization, and control in older adults with asthma

      2013, Journal of Allergy and Clinical Immunology: In Practice
    • Asthma outcomes: Quality of life

      2012, Journal of Allergy and Clinical Immunology
    • Asthma outcomes: Composite scores of asthma control

      2012, Journal of Allergy and Clinical Immunology
      Citation Excerpt :

      Responsiveness over time (with no specifically prescribed therapeutic intervention) has been demonstrated for 8 instruments in at least 1 sample (Table VII), and responsiveness to specific therapy has been demonstrated for 3 instruments (Table VII). Minimal clinically important differences (MCIDs) have been defined for the ACQ (0.5 point),13 the ACT (3 points),14 and the Lara Asthma Symptom Scale in adults (7 points).15 Asthma control score instruments that are clinically useful in individual patients may not be effective for measuring differences between populations in clinical trials and vice versa.

    • Effect of age on asthma control: Results from the National Asthma Survey

      2011, Annals of Allergy, Asthma and Immunology
      Citation Excerpt :

      Although much research and public attention has focused on children and young adults, there has been little research on older adults (>65 years) with asthma.3 In fact, many asthma trials4–7 have routinely excluded participants older than 65 years. It is estimated that approximately 2 million adults older than 65 years in the United States carry a diagnosis of asthma.

    View all citing articles on Scopus

    Supported by the US Department of Health and Human Services (DHHS), the Office of Minority Health (OMH), grants no. D52MP03114-01-0 and D52MP03114-02-0, and the Centers for Disease Control and Prevention (CDC), grant no. R01 EH000095-01.

    Disclosure of potential conflict of interest: M. Lara is employed by Rand Corporation. J. I. Peters has received grant support from the National Institutes of Health and Centocor and is on the speakers' bureau for Merck, GlaxoSmithKline, Boehringer Ingelheim, and Pfizer. The rest of the authors have declared that they have no conflict of interest.

    View full text