Development of an integral assessment approach of health status in patients with obstructive airway diseases: the CORONA study

Figures & data

Figure 1 Eight-step method used for development of the outpatient-based diagnostic pathway for patients with asthma and chronic obstructive pulmonary disease.

Table 1 Selected instruments and subdomains measured for each of the four domains of health status

COPD

1) Main domain physiological functioning

• History: eg, smoking habit, exacerbations, comorbidity

• BMI

• Capillary blood gases

• Spirometry and flow volume curve, reversibility

• Metronome-paced hyperventilation (MPH) test

• Chest X-ray (age >40 years)

2) Main domain symptoms

• Medical Research Council (MRC) dyspnea scale

• CCQ: subdomain symptoms

• NCSI: subdomain dyspnea and fatigue

3) Main domain functional limitations

• CCQ: subdomain functional state

• Dynaport triaxial accelerometer: actual activity level

• NCSI: subdomains subjective and behavioral impairment

4) Main domain quality of life

• CCQ: subdomain emotions

• NCSI: subdomains general quality of life, health-related quality of life, and satisfaction with relations

Asthma

1) Main domain physiological functioning

• History: eg, smoking habit, exacerbations, comorbidity

• BMI

• Capillary blood gases

• Spirometry and flow volume curve, reversibility

• Metronome-paced hyperventilation (MPH) test

• Chest X-ray

• Allergic assessment (RAST and blood eosinophils and total IgE)

• Nitric oxide (FeNO)

2) Main domain symptoms

• ACQ

• Medical Research Council (MRC) dyspnoea scale

• NCSI: subdomains dyspnea and fatigue

3) Main domain functional limitations

• ACQ

• Dynaport triaxial accelerometer: actual activity level

• NCSI: subdomains subjective and behavioral impairment

4) Main domain quality of life

• NCSI: subdomains general quality of life, health-related quality of life, and satisfaction with relations

Abbreviations: RAST, radioallegrosorbent test; IgE, Immunoglobulin E; CCQ, Clinical COPD Questionnaire; NCSI, Nijmegen Clinical Screening Instrument; BMI, body mass index; ACQ, Asthma Control Questionnaire.

Figure 2 Flowchart of the diagnostic pathway.

Abbreviations: ACQ, Asthma Control Questionnaire; GP, general practitioner; MRC, Medical Research Council; CCQ, Clinical COPD Questionnaire; 6-MWD, 6-minute walk distance; MM, move monitor; PAL, physical activity level.

Table S1 Delphi consensus aspects

No	Determinants	Percentage
1	Lung function	98.7
2	Comorbidities	97.5
3	Pulmonary medication	97.5
4	Respiratory complaints	97.5
5	Pulmonary history	96.3
6	Hospital admission last year as a result of exacerbations	96.3
7	ICU admission last year as a result of exacerbations	95.0
8	Physical activity, subjective	95.0
9	Exacerbation frequency last year	93.8
10	Airway obstruction and reversibility	93.8
11	Smoking status	92.5
12	Physical examination	91.5
13	Physical activity, objective	90.0
14	Nonpulmonary medication	88.8
15	Nutritional status	88.8
16	Allergic symptoms	88.8
17	Quality of life, objective	88.8
18	Allergy research (asthma)	87.5
19	Allergy, subjective	86.3
20	Lung volume (restriction, static hyperinflation)	86.3
21	Cardiac complaints	86.3
22	Exposition	82.5
23	Classification of COPD in GOLD	81.3
24	Diffusion capacity	81.3
25	Anxiety and depression	81.3
26	Exercise capacity	80.0
27	Quality of life, subjective	80.0
28	Dynamic hyperinflation	78.8
29	Thorax X-ray	76.3

Notes: Of the 41 selected components for the diagnostic assessment, consensus was reached for 29 components. Consensus was reached when ≥75% of the respondents selected “(very) important” for a specific component rated on a seven-point Likert scale.

Abbreviations: ICU, intensive care unit; COPD, chronic obstructive pulmonary disease; GOLD, global initiative for chronic obstructive pulmonary disease.