Inner-City Asthma Study Questionnaires

QualityTool

Inner-City Asthma Study Questionnaires

Description

These questionnaires were used in the Inner City Asthma Study (ICAS) to evaluate the effectiveness of two types of interventions to reduce asthma morbidity and severity among inner-city children, ages 5-11, with moderate to severe asthma.

Questionnaires include:

  • Adult baseline clinical evaluation form–Completed at study enrollment by the adult caretaker of the child
  • Child baseline clinical evaluation form–Completed at study enrollment by the child
  • Bimonthly followup phone call form–Asthma symptom, medicine, and health care utilization questionnaire completed via telephone every 2 months (for 2 years) by the adult caretaker of the child
  • Home environment survey form–Survey of the child’s home environment completed at baseline and every 6 months afterward by an ICAS Home Evaluator
  • Asthma diary form–2-week diary of daily symptoms, medication use, and home pulmonary function monitoring using a portable monitoring device; completed at 6-month intervals.

These forms can be viewed and printed as PDF files.

Developer:

Inner-City Asthma Study

Funding Sources:

National Institute of Allergy and Infectious Diseases; National Institute of Environmental Health Sciences

History

Release Date: 1998
Original Summary: June 2008
Last Updated: 07/07/08

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