Optimising Asthma Control in a Sub-Saharan African Population: Assessing Agreement among Five Standardized Questionnaires.

Abstract

Background: Asthma management prioritises symptom control, typically assessed using standardized questionnaires. However, comparative data on their performance and agreement remain scarce in Sub-Saharan Africa.

Methods: In a cross-sectional study of 100 adults [79% females, mean age 38.1±14.6 years] with physician-diagnosed asthma at a Nigerian tertiary hospital, asthma control was evaluated using Global Initiative for Asthma (GINA), Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ-7), Royal Society of Physicians 3 Questions (RCP-3Qs) and Asthma Therapy Assessment Questionnaire (ATAQ). Agreement was measured with Cohen's kappa statistics. Diagnostic accuracy for GINA-defined well-controlled asthma was analysed using ROC-derived thresholds, with GINA serving as the reference standard to assess the performance of ACT, ACQ, RCP-3Qs, and ATAQ.

Results: The level of controlled asthma ranged from 73% to 83% across tools. Agreement among control tools was low; GINA showed slight agreement with others (κ = 0.018-0.107), while ACT and ACQ had moderate agreement (κ = 0.546). ACT, ACQ, and RCP-3Qs demonstrated strong diagnostic accuracy for identifying GINA-defined well-controlled asthma (AUC 0.90; 95% CI: ACT 0.76-0.95; ACQ 0.75-0.94; RCP-3Qs 0.78-0.92), whereas ATAQ performed poorly (AUC 0.5; 95% CI: 0.29-0.59). At pre-specified thresholds of >20, ≤1.57, ≤1 and 0.5, the specificity of ACT, ACQ, RCP-3Qs, and ATAQ was 92.6%, 70.4%, 70.4%, and 85.2%, respectively; while sensitivity was 73.7%, 94.7%, 100%, and 26.3%.

Conclusion: ACT, ACQ, and RCP-3Q effectively identified GINA-defined well-controlled asthma, while ATAQ showed poor diagnostic value. Low agreement among the tools suggests they are not interchangeable for assessing asthma control.