Photo Credit: Iurii Krasilnikov
An allergist shares how the AIRQ can benefit shared decision-making, ultimately improving patient care, treatment adherence, trust, and asthma outcomes.
Several validated tools exist for assessing asthma in the clinical setting, including the Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), and Asthma Impairment and Risk Questionnaire (AIRQ). Authors of an editorial published in Annals of Allergy, Asthma & Immunology examined factors that influence the choice between these tools, noting that the AIRQ can be uniquely beneficial for guiding care in patients with asthma.
In an interview with Physician’s Weekly (PW), corresponding author Don A. Bukstein, MD, describes the benefits of the AIRQ and how clinicians can use this tool to enhance shared decision-making and their relationships with patients.
PW: How do you assess asthma control in your patients?
Dr. Bukstein: Asthma control is essential. I started working on asthma control tests almost 40 years ago. We developed a test called the Asthma Therapy Assessment Questionnaire (ATAQ), which gave way to the ACT. I have been working to shorten asthma control tests and make them more functional.
This all starts with patient-centered care. Patients sometimes come to us without well-defined goals. The patient needs to know when their asthma is well controlled, according to them and their caregiver. Deciding with the patient on their therapy goals is the mainstay of diagnosing and treating asthma.
What are the advantages of using the AIRQ over the ACQ and ACT in clinical practice?
The guidelines divided domains into impairment and risk. We’ve typically used the ACT, which specifically looks at the impairment domain. I like the AIRQ the best because it incorporates the two domains of impairment and risk into one questionnaire.
The AIRQ is easy to use. It’s ‘yes’ and ‘no,’ so it’s quick—we don’t have to explain a Likert scale or some other scale, which can be confusing. Different populations seem to understand the AIRQ questions because we have worked out their demographics and language well.
We have a QR code where patients can fill out the AIRQ before their appointment. It makes the visit more efficient for everyone and supplies better, more robust information for decision-making.
Sometimes, a nurse reviews the AIRQ with the patient the first time, and then at subsequent visits, our patients get used to filling it out. When they become comfortable using it, they can say, “My AIRQ today is …” without filling out the questionnaire.
Patients want to know their risks and impairments and want us to define them. That’s all well and good, but clinicians can’t define them by ourselves. Even with these questionnaires, we need the patients’ help in understanding what they view as their impairment, risk, and goals before we can discuss treatment.
How do you integrate patient perspectives into asthma management using tools like the ACT and AIRQ?
It is so important to get the patient’s viewpoint. Clinical decisions can build or destroy trust and make or break a relationship. One of the best trust-builders is to involve the patient in their care and show that you’re interested. You can incorporate both shared decision-making and the AIRQ into your follow-up.
Treatment paradigms for asthma are changing, and our decisions in asthma treatment are highly appropriate for shared decision-making. You can deal with misinformation upfront. You can offer patients a choice so they understand the literature, their goals of therapy, the risks and benefits of each therapy, and possible incentives to take therapy. You don’t have to use teach-back only to see if patients use their inhalers correctly. You also can use it to check if the patient understands whether they are a candidate for a biologic. You can teach them what a biologic is.
Often, patients don’t know how to assess whether they’re better, the same, or worse. The AIRQ accounts for exacerbations and gives patients a marker. The patient can say, “If my AIRQ gets better, I’m successful.”
Finally, using the AIRQ and shared decision-making builds empathy. Empathy is a big deal. If you have empathy and trust, your patients’ adherence to treatment will improve, your communication will improve, and your care will be better overall.
Is there anything else you want to add?
In the end, the AIRQ represents an opportunity to better understand your patient and their asthma control. Shared decision-making expands that information, leading to meaningful behavior changes and the creation of mutually satisfactory therapeutic goals that center around the AIRQ.
I find the AIRQ to be a great instrument. It’s not too wordy. It can be used in almost any setting and any population. It works as well as if you were evaluating biomarkers like exhale, nitric oxide, and eosinophil count.
I encourage people to practice with their staff, make a QR code, and work on building trust with patients. Say, “Tell me about yourself,” and then listen. I think shared decision-making and the AIRQ define patient-centered care in asthma and should be part of everybody’s practice.
