Assessing Asthma Symptoms in Adolescents and Adults: Qualitative Research Supporting Development of the Asthma Daily Symptom Diary

Adam Gater, Linda Nelsen, Sarah Fleming, J. Jason Lundy, Nicola Bonner, Rebecca Hall, Chris Marshall, Hannah Staunton, Jerry A. Krishnan, Stuart Stoloff, Michael Schatz, John Haughney, Patient-Reported Outcome Consortium’s Asthma Working Group

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Abstract

Background
Despite the widespread availability of patient-reported asthma questionnaires, instruments developed in accordance with present regulatory expectations are lacking. To address this gap, the Patient-Reported Outcome (PRO) Consortium’s Asthma Working Group has developed a patient-reported asthma daily symptom diary (ADSD) for use in clinical research to assess outcomes and support medical product labeling claims in adults and adolescents with asthma.

Objectives
To summarize the qualitative research conducted to inform the initial development of the ADSD and to provide evidence for content validity of the instrument in accordance with the Food and Drug Administration’s PRO Guidance.

Methods
Research informing the initial development and confirming the content validity of the ADSD is summarized. This comprised a review of published qualitative research, semi-structured concept elicitation interviews (n = 55), and cognitive interviews (n = 65) with a diverse and representative sample of adults and adolescents with a clinician-confirmed diagnosis of asthma in the United States to understand the asthma symptom experience and to assess the relevance and understanding of the newly developed ADSD.

Results
From the qualitative literature review and concept elicitation interviews, eight core asthma symptoms emerged. These were broadly categorized as breathing symptoms (difficulty breathing, shortness of breath, and wheezing), chest symptoms (chest tightness, chest pain, and pressure/weight on chest), and cough symptoms (cough and the presence of mucus/phlegm). Conceptual saturation was achieved and differences in the experience of participants according to socio-demographic or clinical characteristics were not observed. Subsequent testing of the ADSD confirmed participant relevance and understanding.

Conclusions
The ADSD is a new patient-reported asthma symptom diary developed in accordance with the Food and Drug Administration’s PRO Guidance. Evidence to date supports the content validity of the instrument. Item performance, reliability, and construct validity will be assessed in future quantitative research.
Original languageEnglish
Pages (from-to)440-450
Number of pages11
JournalValue in Health
Volume19
Issue number4
Early online date30 Mar 2016
DOIs
Publication statusPublished - Jun 2016

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Keywords

  • asthma
  • content validity
  • patient-reported outcomes
  • symptoms

Cite this

Gater, A., Nelsen, L., Fleming, S., Lundy, J. J., Bonner, N., Hall, R., Marshall, C., Staunton, H., Krishnan, J. A., Stoloff, S., Schatz, M., Haughney, J., & Patient-Reported Outcome Consortium’s Asthma Working Group (2016). Assessing Asthma Symptoms in Adolescents and Adults: Qualitative Research Supporting Development of the Asthma Daily Symptom Diary. Value in Health, 19(4), 440-450. https://doi.org/10.1016/j.jval.2016.01.007