There were a few research tools that were used in the study. The first tool was the asthma education flip chart. It was a laminated, colorful flip chart used to deliver standard asthma education to both caretakers and patients. It was obtained from the Health Education Department, Ministry of Health Malaysia. The content of the pamphlet included the nature of the disease, exacerbating factors, different uses of medications, and inhaler techniques. The correct inhaler technique was discussed and emphasized during the visit. Notably, several caregivers and patients were comfortable with using a spacer for better delivery of medications. The researcher explained and demonstrated the correct use of a metered-dose inhaler (MDI) and spacer using a sample MDI and spacer.
The second research tool was a WAAP. An asthma action plan is an individualized written instruction to the patients and caretakers on how to monitor the symptoms of asthma, adherence to medications, and how to recognize exacerbations; thus, prompt action can be taken at home. They were taught how to recognize the severity of an exacerbation and, thus, adjust the medications accordingly. They were also educated on when to seek early medical attention.
The third tool was ACQ. This study had written permission to use ACQ, which was developed by Dr. Elizabeth Juniper. It is a worldwide validated questionnaire that is used with subjects aged 7–17 years. ACQ has strong evaluative and discriminative properties and can be used with confidence to measure asthma control [8 (
link)]. It includes seven questions regarding the daytime and nighttime symptoms, limitation of daily activity, wheezing, bronchodilator use, and measurement of forced expiratory volume at 1 second or PEFR. Patients were asked to recall their asthma symptoms over the previous week and respond to questions on a 7-point scale. For analysis, a higher score indicated worse asthma control. A score of ≤0.75 was regarded as controlled asthma, and ≥1.5 was regarded as uncontrolled asthma. An in-between value was regarded as partly controlled asthma.
ACQ had been translated into Malay, widely used across the regions, and has been translated by the Modified Asthma Predictive Index (MAPI) Research Institute, Lyon, France [9 ]. Interviewer-administered ACQ took place without the caretakers in the room to avoid bias. Generally, all the patients recruited were able to describe their symptoms well. However, when the research was conducted, a recall bias was anticipated, and to minimize this, the PEFR value was compared with the previous PEFR for medication adjustment.
The fourth tool was PAQLQ. It was also developed by Dr. Elizabeth Juniper and showed good validity as an evaluative instrument in patients aged 7–17 years [10 (
link)]. Studies showed that children as young as 7 years old had no difficulties understanding the questions and were able to provide accurate responses with a Cronbach’s α of 0.87 [11 (
link),12 (
link)]. A study that used the Malay-translated PAQLQ also did not report any difficulties in using the questionnaires when given to patients aged 6–17 years [6 (
link)].
The PAQLQ consisted of 23 questions covering three major domains in assessing the quality of life: activity limitations, symptoms, and emotional function. It is a Likert-scaled questionnaire, scoring 1 to 7, where 1 indicates severe impairment and 7 indicates no impairment. Thus, in PAQLQ scoring and analysis, a higher score reflects a better quality of life and is analyzed using the mean score. The validity was tested in several countries. It was culturally adapted and translated into multiple languages again by the MAPI Research Institute, Lyon, France [13 ].
Muhammad J., Ngah N.D, & Ahmad I. (2023). Written Asthma Action Plan Improves Asthma Control and the Quality of Life among Pediatric Asthma Patients in Malaysia: A Randomized Control Trial. Korean Journal of Family Medicine, 44(1), 44-52.