Assessing asthma control in routine clinical practice: use of the Royal College of Physicians '3 questions'

01 Jun 2009
Respiratory conditions
  • Asthma
Respiratory topics
  • Disease management
Type of resource
Peer-reviewed article
Thomas M, Gruffydd-Jones K, Stonham C, Ward S, Macfarlane TV


To evaluate the Royal College of Physicians (RCP) '3 questions' in the assessment of asthma control.


This was a prospective observational study. Subjects (20 adults and 15 children) were assessed 2-weekly over 12 weeks, with data collection on RCP scores (yes/no for each question, 0-3), lung function, asthma control questionnaire (ACQ), asthma quality of life questionnaires (AQLQ), bronchodilator use, and exhaled nitric oxide level.


Between-subject analysis showed that the RCP score correlated strongly with the ACQ (correlation coefficient 0.79, p<0.001), AQLQ (-0.71, p=0.001) and bronchodilator use (0.52, p=0.02) in adults, although in children the correlations were weaker and nonsignificant. Within-subject analysis showed strong correlations between changes in the RCP score and ACQ score in adults (0.67, p<0.001) and children (0.61, p<0.001), between quality of life scores in adults (-0.67, p<0.001) and children (-0.69, p<0.001), and changes in bronchodilator use in adults (0.49, p<0.001) and children (0.48, p<0.001). Weaker or absent correlations existed with lung function and no correlations with exhaled nitric oxide levels. An RCP score of 1 or more identified 89% of occasions when the ACQ was >1.


The RCP 3 questions reliably quantify current asthma control in this dataset, with a negative response to all 3 questions indicating good control. These data support the use of the 3 questions, but larger validation studies are needed.