Assessment of asthma severity in adults with asthma treated by family practitioners, allergists, and pulmonologists

Med Care. 1998 Nov;36(11):1567-77. doi: 10.1097/00005650-199811000-00006.


Objectives: Accurate measurement of asthma severity is critical for research evaluating asthma health outcomes. There are, however, no widely accepted asthma severity measures. A severity-of-asthma score, which is based on self-reported information, was previously developed and validated in subjects recruited from pulmonary and allergy subspecialty practices. The purpose of this study was to validate the severity-of-asthma score in subjects treated by family practice physicians and to compare asthma severity in subjects treated by family practitioners (n = 150) with those seen by allergists (n = 217) and pulmonologists (n = 384).

Methods: The study was an ongoing panel study of adults with asthma. Subjects were a random sample of board-certified family practice, allergy, and pulmonary physicians. Each physician registered patients with asthma aged 18 to 50 years. Of 869 subjects registered, 751 (86%) completed structured telephone interviews. The family practice panel was recruited approximately 3 years after the subspecialty panel.

Results: In the family practice subjects, the severity-of-asthma score demonstrated internal consistency (Cronbach's alpha 0.76) and concurrent validity, correlating strongly with asthma-specific quality of life, SF-36 General Health and Physical Functioning scales, and subject-perceived asthma severity. After controlling for demographic characteristics, a 5-point score increment was associated with increased emergency department visits, urgent physician visits, and restricted activity days. The mean severity score was highest in the pulmonary group (11.8 +/- 6.3), followed by the allergy (10.3 +/- 5.3) and family practice (9.3 +/- 5.5) groups.

Conclusions: The severity-of-asthma score was a valid measure in generalist-treated subjects. Asthma severity varied significantly by physician specialty.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Allergy and Immunology / statistics & numerical data*
  • Anti-Asthmatic Agents / administration & dosage
  • Asthma / classification*
  • Asthma / diagnosis
  • Asthma / rehabilitation*
  • Family Practice / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Practice Patterns, Physicians'
  • Pulmonary Medicine / statistics & numerical data*
  • Quality of Life
  • Severity of Illness Index*
  • Treatment Outcome
  • United States


  • Anti-Asthmatic Agents