Md. Eisner et al., ASSESSMENT OF ASTHMA SEVERITY IN ADULTS WITH ASTHMA TREATED BY FAMILYPRACTITIONERS, ALLERGISTS, AND PULMONOLOGISTS, Medical care, 36(11), 1998, pp. 1567-1577
OBJECTIVES. Accurate measurement of asthma severity is critical for re
search evaluating asthma health outcomes. There are,however, no widely
accepted asthma severity measures. A severity-of-asthma score, which
is based on self-reported information was previously developed and val
idated in subjects recruited from pulmonary and allergy subspecialty p
ractices. The purpose of this study was to validate the severity-of-as
thma score in subjects treated by family practice physicians and to co
mpare asthma severity in subjects treated by family practitioners (n =
150) with those seen by allergists (n = 217) and pulmonologists (n =
384). METHODS. The study was an ongoing panel study of adults with ast
hma. Subjects were a random sample of board-certified family practice,
allergy, and pulmonary physicians. Each physician registered patients
with asthma aged 18 to 50 years. Of 869 subjects registered, 751 (86%
) completed structured telephone interviews. The family practice panel
was recruited approximately 3 years after the subspecialty panel. RES
ULTS. In the family practice subjects, the severity-of-asthma score de
monstrated internal consistency (Cronbach's alpha 0.76) and concurrent
validity, correlating strongly with asthma-specific quality of life,
SE-36 General Health and Physical Functioning scales, and subject-perc
eived asthma severity. After controlling for demographic characteristi
cs, a 5-point score increment was associated with increased emergency
department visits, urgent physician visits, and restricted activity da
ys. The mean severity score was highest in the pulmonary group (11.8 /- 6.3), followed by the allergy(10.3 +/- 5.3) and family practice (9.
3 +/- 5.5) groups. CONCLUSIONS. The severity-of-asthma score was a val
id measure in generalist-treated subjects. Asthma severity varied sign
ificantly by physician specialty.