Chest
Special ReportAsthma and Asthma-like Symptoms in Adults Assessed by Questionnaires: A Literature Review
Section snippets
The Questionnaires
In the Medical Research Council (MRC) questionnaire,1, 2 the items were selected for identification of chronic bronchitis. The “British hypothesis” stated that the presence of chronic cough and sputum were predictors of chronic respiratory disability.7 In the 1960 version of the MRC questionnaire, there were only a few questions about wheezing and unspecified chest illnesses. In the 1966 version, this topic was expanded with questions about attacks of shortness of breath and wheezing. A
Assessment of Validity
There are few published studies dealing with the validity of the questions about asthma and asthma-like symptoms. In many studies, the “cases” have been investigated, but to assess the validity, a sample of those screened as negative by the questionnaires must also be investigated.
The answers to a questionnaire are affected by the mode of administration and the formulation of the questions. Regarding items dealing with asthma-like symptoms, validity is probably only slightly influenced by
Assessment of Reliability
The agreement of response between two administrations of the same questionnaire is an appropriate measure of reliability.35 Of course, such an approach is based on the assumption that the investigated conditions do not change in the time interval between the examinations. Items about respiratory symptoms are probably more affected by real variation than items about medical diagnosis such as asthma. The interval between the distributions of the questionnaires is also of importance. If the
Discussion
One major disadvantage in the development of a questionnaire for athma and asthma-like symptoms is the lack of a generally accepted definition of asthma. The definition has been intensively discussed over the years,38 and the description of asthma has been focused on narrowing of the airways and the increased responsiveness to various stimuli. This is an illusory consensus because there was no agreement on any operational criteria, ie, which symptoms or which clinical physiologic
Conclusions
Questionnaires, including questions about asthma and asthma-like symptoms, should be validated against clearly stated operational definitions of asthma. This operational definition must include both clinical physiologic findings and a clinical history.
When selecting items about asthma and asthmalike symptoms, questions with high specificity should be preferred in most situations. Questions about “self-reported” asthma, especially “physician-diagnosed” asthma, have such properties.
Questions
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This work was supported bv Swedish Work Environment Fund Dnr 91–0157.