Daytime and Nighttime Visual Analog Scales May Be Useful in Assessing Asthma Control Levels Before and After Treatment

Figures & data

Figure 1 Study protocol.

Notes: The delta was expressed as different values from before treatment to 4 weeks or from before treatment 8 weeks after treatment.

Abbreviations: F_ENO, fractional exhaled nitrogen oxide; PROs, patient-reported outcomes.

Figure 2 Flowchart of patient enrollment.

Notes: The controller-naïve, symptomatic, non-smoking, adult patients who underwent daytime and nighttime VAS assessments before treatment, and 4 and 8 weeks after treatment with ICS/LABA combination therapy, were enrolled at Fujiki Medical and Surgical Clinic between December 2020 and May 2021.

Abbreviations: ACT, asthma control test; ICS, inhaled corticosteroids; LABA, long-actingβ₂ agonists; VAS, visual analog scale.

Figure 3 The correlation between ACT scores, and daytime and nighttime VAS before treatment.

Abbreviations: ACT, asthma control test; VAS, visual analog scale.

Table 1 Profiles of Patients with Asthma Before Treatment

Characteristics	n = 55
Age, years (range)	49.7 ± 16.1 (20 to 86)
Female gender, n (%)	42 (76.4)
Body mass index, kg/m^2 (range)	22.9 ± 3.6 (17.7 to 38.3)
Body mass index >25 kg/m^2 (obese), n (%)	12 (21.8)
Any other allergic comorbidities	21 (38.2)
Allergic rhinitis	20 (36.4)
Chronic sinusitis with nasal polyps	1 (1.8)
Atopic dermatitis	1 (1.8)
Biomarkers
White blood cells count, x10^9cells/L	6.2 ± 1.4
% Eosinophils, %	3.8 ± 2.3
% Neutrophils, %	54.9 ± 7.5
Eosinophil count, x10^3 cells/µL	239 ± 157
Neutrophil count, x10^3 cells/µL	2072 ± 291
Serum total IgE levels, U/mL	140 ± 230
FENO, ppb	45.3 ± 36.6
PROs
ACT scores, points (range)	13.9 ± 3.0 (9 to 19)
VAS, cm (range)
Daytime	7.3 ± 1.8 (2.0 to 10.0)
Nighttime	7.7 ± 1.9 (3.0 to 10.0)
Lung function
FVC, L	2.76 ± 0.75
%FVC predicted, %	96.6 ± 18.6
FEV1, L	2.18 ± 0.68
%FEV1 predicted, %	91.3 ± 22.1
FEV1/FVC ratio	0.78 ± 0.10
Spirometric ventilatory pattern, n (%)
Obstructive ventilatory pattern	10 (18.2)
Restrictive ventilatory pattern	3 (5.4)
Selected ICS/LABA combination therapy, n (%)
Doses of ICS
High dose	22 (40.0)
Medium dose	33 (60.0)
Administration
Once a day	26 (47.3)
Twice a day	29 (52.7)

Notes: Data are expressed as mean ± standard deviation and number (%) of patients. Doses of ICS were classified according to the Global Initiative for Asthma criteria. In other medicines, none of the patients were administered slow-release theophylline, regular oral prednisolone, and biologics. The number (%) of patients who received leukotriene receptor antagonists and anti-allergic agents, whose administration was ongoing for other allergic comorbidities prior to the use of ICS/LABA therapy, was 25 (45.4) and 12 (21.8), respectively. However, data were missing for two patients for blood tests, one for F_ENO, and one for lung function test 8 weeks after treatment.

Abbreviations: ACT, asthma control test; F_ENO, fractional exhaled nitrogen oxide; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; ICS, inhaled corticosteroid; Ig, immunoglobin; LABA, long-acting β₂ agonist; PROs, patient-reported outcomes; VAS, visual analog scale.

Figure 4 Changes in the mean ACT scores, and daytime and nighttime VAS after treatment.

Notes: All data were expressed as mean (open circles) ± SD (bars). Data of baseline were the values of PROs before treatment.

Abbreviations: ACT, asthma control test; PROs, patient-reported outcomes; VAS, visual analog scale.

Table 2 Multiple Regression Analysis of Changes in PROs and Changes in Lung Functions and F_ENO 8 Weeks After Treatment

Covariates	ACT Scores		Daytime VAS		Nighttime VAS
	β (95% CI)	P value	β (95% CI)	P value	β (95% CI)	P value
Changes in FENO, ppb	0.15 (−0.04 to 0.08)	0.5	−0.02 (−0.05 to 0.00)	0.1	−0.01 (−0.05 to 0.03)	0.6
Changes in FVC, L	3.47 (−1.46 to 8.41)	0.5	−2.33 (−4.55 to −0.11)	0.0405*	−3.09 (−6.25 to 0.07)	0.0505
Changes in FEV1, L	−1.73 (−6.78 to 3.33)	0.5	1.18 (−1.09 to 3.46)	0.3	2.63 (−0.61 to 5.87)	0.1

Notes: The multiple regression analysis was adjusted for covariates, the following age, gender, body mass index, and the presence of other allergic comorbidities before treatment. *P <0.05 with a significant correlation between changes in daytime VAS and FVC.

Abbreviations: ACT, asthma control test; CI, confidence interval; F_ENO, fractional exhaled nitrogen oxide; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; PRO, patient-reported outcome; VAS, visual analog scale.

Figure 5 The correlation between changes in the ACT scores, and daytime and nighttime VAS from before to 8 weeks after treatment.

Abbreviations: ACT, asthma control test; VAS, visual analog scale.