A36-16 Performance of Individual Asthma Impairment and Risk Questionnaire (AIRQ®) Items in Identifying Current Control and Future Exacerbation Risk Among Patients Categorized as Having Well-controlled Disease

Rationale The Asthma Impairment and Risk Questionnaire (AIRQ) is a 10-item, equally weighted, yes/no assessment for patients ≥12 years that differentiates current control and predicts exacerbations better than impairment-only tools, physician evaluation, or individual AIRQ questions (Chipps, Ann Allergy Asthma Immunol, 2024; Beuther, J Allergy Clin Immunol Pract, 2022). Against a standard of Asthma Control Test (ACT™) score plus prior-12-month exacerbations, 2 multivariable logistic regression models identified 10 of 15 evaluated questions whose summed score provided the greatest ability to discriminate control levels (Murphy, J Allergy Clin Immunol Pract, 2020). AIRQ questions are generally concordant with expert consensus thresholds for well-controlled asthma. One consensus concept commonly used to differentiate uncontrolled from well-controlled disease—rescue use >4 times over 2 weeks—was evaluated in the AIRQ validation study. This consensus-based item did not contribute to differentiating control, whereas “daily rescue use,” was significant in both models and included in AIRQ. As 0 or 1 ‘yes’ responses represent well-controlled asthma, we examined how a single ‘yes’ response to any AIRQ question performed in classifying control and predicting exacerbations and compared performance of AIRQ-validated versus consensus-based rescue item. Methods Patients assessed as well-controlled by AIRQ at baseline and who provided longitudinal follow-up data were included. Patient-reported exacerbations were assessed monthly over 12 months. The number of well-controlled patients responding ‘yes’ to each AIRQ question at baseline, and the number of these ‘yes’ responders with subsequent-year exacerbations, were determined for each question when assessing control with the 10 validated AIRQ items and when the consensus-based rescue item was substituted for the validated rescue use question. Results 375/1064 patients had well-controlled asthma per AIRQ. The proportion of well-controlled patients responding ‘yes’ to an AIRQ item ranged from 0% (‘hospitalization’) to 14.9% (‘limited exercise ability’). The proportion responding ‘yes’ to an individual question who experienced subsequent exacerbation ranged from 0.3% (“daily activity limitation,” “daily rescue use,” “social activity limitation,” “asthma difficult to control”) to 3.5% (“oral steroid use”) (Figure). Using the consensus-based rescue item with the other 9 validated AIRQ questions resulted in 359/1064 well-controlled patients. Among the well-controlled populations, 5.8% versus 2.1% responded ‘yes’ to > 4 times versus daily rescue use over 2 weeks; 1.9% versus 0.3% of these well-controlled ‘yes’ responders experienced subsequent exacerbations. Conclusion Our findings support utilizing AIRQ in its totality to assess control and predict exacerbations over any individual item, whether or not that item is concordant with consensus-based thresholds for well-controlled disease. This abstract is funded by: AstraZeneca