P2.092: Evaluating the Construct Validity of a Follow-up Pediatric Asthma Impairment and Risk Questionnaire that Employs 3-month Exacerbation Recall Items

Background: Over 40% of children aged < 18 years with asthma have uncontrolled disease, with over half experiencing annual exacerbations. Uncontrolled disease and prior-year exacerbations increase future exacerbation risk. At point-of-care, identifying children with uncontrolled asthma who are at risk for exacerbations is critical to optimize management and prevent exacerbation-associated systemic corticosteroid exposures. The Pediatric Asthma Impairment and Risk Questionnaire (Peds-AIRQ®) is a newly validated control tool for children with asthma aged 5-11 years comprising 5 symptom-based impairment questions with a 2-week recall period and 3 exacerbation history-based risk items with a 12-month recall period; 0-1 “Yes” responses represent well-controlled (WC), 2-4 not well-controlled (NWC), and 5-8 very poorly controlled (VPC) asthma (FIGURE 1A). Against a validation standard of impairment (GINA symptom control level) and risk (prior-year chart-documented exacerbations), Peds-AIRQ is 88% sensitive and 95% specific for identifying WC vs NWC+VPC and WC+NWC vs VPC asthma, respectively. As asthma control is often measured more frequently than annually, this analysis assessed construct validity of a Follow-up Peds-AIRQ (FIGURE 1B) that uses a 3-month recall period for the exacerbation items instead of a 12-month recall.

Methods: 399 parents/caregivers and their children with asthma aged 5-11 years participated in a 3-month Peds-AIRQ longitudinal validation study (WCG IRB: 20234200). At baseline, the Peds-AIRQ, Childhood Asthma Control Test (C-ACT™), Pediatric Quality of Life Inventory (PedsQL), and a Likert scale assessing symptom severity were completed. Assessments were repeated at month 3, except Peds-AIRQ was substituted with a follow-up version employing a 3-month recall for risk items. Parent-reported exacerbations were captured monthly during follow-up. Relationships between Follow-up Peds-AIRQ scores and clinical assessments performed at month 3 were analyzed by Spearman correlations. Associations between Follow-up Peds-AIRQ control categories and exacerbation occurrence from baseline through month 3 were assessed by general linear models and Scheffe’s post-hoc adjustments for pairwise comparisons.

Results: Three-month data were available for 261 children. Mean (standard deviation [SD]) age=8.0(1.9) years; 65.9% male; 74.3% White children and 14.9% African American/Black/mixed-race African American/Black children; 21.1% Hispanic/Latino children; 24.1% treated as intermittent and 8.4%, 58.2%, and 9.2% as mild, moderate, or severe persistent asthma; 39.1% with public/no health insurance; Follow-up Peds-AIRQ mean(SD) score at month 3: 1.6(1.9); 59% WC, 30% NWC, and 11% VPC. Follow-up Peds-AIRQ score was significantly correlated with C-ACT (-0.66), PedsQL (-0.41), and parent/caregiver opinion of their child’s symptom severity (0.65): p< 0.001, for each. The proportion of children who experienced ≥1 and ≥2 exacerbations from baseline through month 3 increased with worsening Follow-up Peds-AIRQ control category (FIGURE 2); p< 0.001 for both.

Conclusion: The Follow-up Peds-AIRQ using exacerbation risk items with a 3-month recall period exhibits construct validity for classifying current asthma control and can be administered between annual Peds-AIRQ assessments to evaluate children aged 5-11-years with asthma.