Patient-reported outcome measures in severe asthma: an expert consensus

Figures & data

Figure 1. Project phases.

Figure 2. PRISMA flow diagram.

Table 1. PROs and PROMs identified in the literature review.

Symptom-related PROs (n = 24)
Chest tightness Shortness of breath/difficulty in breathing (Dyspnea) Difficulty in exhaling Deep, labored breathing Wheezing Feeling of suffocation	Coughing Coughing (throat clearing) Phlegm Sleep disorders Nocturnal awakening Snoring	Apnea Chest pain Pain (general) Localized pain (face, back, abdomen) Ear symptoms (Ear pain; Itchy ears, Clogged ears)	Fatigue Gastrointestinal disorders (diarrhea, vomiting) Dizziness/vertigo Urticaria Injection site reaction Eye symptoms (conjunctivitis) Taste/ smell disorders
Global PROs (n = 8)
HRQoL	Anxiety		Embarrassment
Treatment satisfaction	Depression		Concentration difficulties
Treatment adherence	Frustration, irritability, and restlessness
PROMs (n = 21)
AQLQ	Dyspnea-12	EQ-5D	Symptom diary
Mini-AQLQ	LCQ	SF-36	Self-report
AC-QoL	SNOT-22	TSQM-9	Questions during medical visits
ACQ	STOP-BANG	HADS	Electronic registration
ACT	MOS	BDI-II
SGRQ	ISI

PROs: Patient-Reported Outcomes; PROMs: Patient-Reported Outcome Measures; HRQoL: Health-Related Quality of Life; AQLQ: Asthma-related Quality-of-Life Questionnaire; Mini-AQLQ: Mini Asthma Quality of Life Questionnaire; AC-QoL: Adult Carer Quality of Life Questionnaire; ACQ: Asthma Control Questionnaire; ACT: Asthma Control Test; SGRQ: St George’s Respiratory Questionnaire; Dyspnea-12: Multidimensional Dyspnea-12 Questionnaire; LCQ: Leicester Cough Questionnaire; SNOT-22: 22-item Sinonasal Outcome Test.; STOP-BANG: Obstructive Sleep Apnea Questionnaire; MOS: Medical Outcomes Study sleep scale; ISI: Insomnia Severity Index; EQ-5D: European Quality of Life-5 Dimensions; SF-36: Medical Outcomes Study 36-Item Short-Form Health Survey; TSQM-9: Treatment Satisfaction Questionnaire for Medication; HADS: Hospital Anxiety and Depression Scale; BDI-II: beck depression inventory-II.

Table 2. PROs and PROMs classification proposed by nominal groups.

PRO		Core PROMs							Complementary PROMs
		ACT	Mini-AQLQ	EQ-5D	mMRC	TAI	MMAS	Dispensing register*	SNOT 22	PSQI	HADS	WPAI	TQSM 9	Knowledge of asthma
Symptom-related PROs	Dyspnea	X	X		X
	Chest tightness		X
	Wheezing		X
	Coughing		X						X
	Nocturnal awakening	X							X	X
Symptom-related PROs	Blocked nose								X
	Sleep disorders	X	X						X	X
	Fatigue								X
	Taste/smell disorders								X
	Anxiety		X	X							X
	Depression		X	X					X		X
Other PROs	HRQoL	X	X	X
	Treatment satisfaction												X
	Treatment adherence					X	X	X
	Work productivity and activity impairment	X
	Knowledge about asthma								X					X

PRO: Patient-Reported Outcome; PROM: Patient-Reported Outcome Measure; HRQoL: Health-Related Quality of Life; ACT: Asthma Control Test; EQ-5D: European Quality of Life-5 Dimensions; Mini-AQLQ: Mini Asthma Quality of Life Questionnaire;; mMRC: Medical Research Council modified Dyspnea Scale; MMAS: Morisky-Green Medication Adherence Scale; TAI: Test of the Adherence to Inhalers; SNOT-22: 22-item Sinonasal Outcome Test; PSQI: Pittsburgh Sleep Quality Index; HADS: Hospital Anxiety and Depression Scale; WPAI: Work Productivity and Activity Impairment Questionnaire; TQSM-9: Treatment Satisfaction Questionnaire for Medication; Knowledge of asthma: Patients’ knowledge of asthma questionnaire (51); *Not a PROM, recommended to assess treatment adherence.

Figure 3. Core group of measurement instruments in order of priority, PROs considered relevant for assessment of severe asthma, and frequency of measurement.

Figure 4. Complementary PROMs recommended for use in certain circumstances or interventions related to severe asthma and frequency of measurement.

Philpot LM, Barnes SA, Brown RM, Austin JA, James CS, Stanford RH, Ebbert JO. Barriers and benefits to the use of patient-reported outcome measures in routine clinical care: A qualitative study. Am J Med Qual. 2018;33(4):359–364. doi:10.1177/1062860617745986.

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