Pediatric Asthma Symptom Scale from RAND Health

How to Use and Score the Asthma Symptom Scale

Two different methods for using the scale, face-to-face or self-administered, are shown below, in both English and Spanish. To determine the frequency and severity of the asthma symptoms, add up the scores for each of the eight individual items. For each item, the least frequent/least severe symptoms equals a (1) the most frequent/most severe equals a (5). Total scores range from 5 to 40, with higher scores indicating more severe and frequent symptoms. The number of asthma attacks are categorized as follows: 1 (0 attacks last month), 2 (1 attack), 3 (2-4 attacks), 4 (5-12 attacks), and 5 (more than 13 attacks).

Important Caveats for the Use of This Tool

It is essential that individuals administering the questions on the Asthma Symptom Scale be fully bilingual, with a keen awareness of such issues as skill level among individuals within a low literacy population. Specifically, those administering the tool must be sensitive to the reading and writing ability of each participant, and be aware that assistance in reading and understanding the questions may be required.

To judge the appropriateness of the scale to a particular population, thereby ensuring optimal validity of the results, the original patient population and clinical setting in which this tool was introduced must be taken into account. To date, this tool has been tested only in children experiencing an asthma exacerbation in an emergency room setting. It has not been tested in an outpatient clinical environment. The scale's reliability has exceeded the standards for group comparisons. However, its ability to adequately measure individual changes has not been established. Also, the clinical interpretation of points along the scale continuum is as yet unknown. Keeping these cautions in mind will help avoid misinterpretation of the usefulness of the tool and of what it can reliably measure.

Pediatric asthma survey measures have not been adequately tested in non-English-speaking populations. The authors evaluated the reliability, validity, and language equivalency of an English and Spanish symptom scale to measure asthma control in children. Parents of 234 children seen in emergency rooms for asthma were asked to report on the frequency and severity of their children's asthma symptoms at the beginning and after the resolution of the exacerbation. An eight-item scale composed of reports of cough, wheezing, shortness of breath, asthma attacks, chest pain, night symptoms, and overall perceived severity had very good psychometric properties in both English and Spanish. The reliability (Cronbach's a ) of the scale ranged from 0.81 to 0.87 for both languages, exceeding the standards for group comparisons. Its ability to adequately measure individual change has not been established. There were no statistically significant differences in the reliability or construct validity of the summary symptom scale by language. The results of this evaluation indicate that the eight-item scale is a reliable and valid tool that can be used to measure control of asthma symptoms in Spanish-speaking populations of low literacy.

Medical professionals working with asthma patients are encouraged to freely use this measure: formal permission is not required. The investigators who developed this scale would be interested in hearing from users about their experiences with it.

This work was conducted under the auspices of the UCLA/RAND Program on Latino Children with Asthma (Division of General Pediatrics, UCLA Department of Pediatrics, and RAND Health, Los Angeles, California).

The questions that appear here, which constitute the eight-item scale that measures the control of asthma, are reprinted with permission of the publisher, © 2000 Lippincott Williams & Wilkins, Inc.

Available Documents

Asthma Symptom Scale: Self-Administered