Why use it

AIRQ is the only validated asthma questionnaire that explicitly and simultaneously measures both impairment and risk — the two pillars of NAEPP asthma control assessment. Validated across diverse patient populations. Enables tracking of both short-term symptom control and long-term exacerbation risk at every clinic visit. Supports step-up or step-down decisions in asthma management.

About

The Asthma Impairment and Risk Questionnaire (AIRQ) is a validated 10-item patient-reported outcome measure that simultaneously assesses two key domains of asthma control as defined by NAEPP (National Asthma Education and Prevention Program): current impairment (symptom burden and quality of life) and future risk (likelihood of exacerbations). Unlike the ACT or ACQ, the AIRQ explicitly incorporates both domains, aligning with NAEPP and GINA guidelines that define asthma control as encompassing both current impairment and future risk. It was designed for use in primary care and specialty practice.

When to use

Routine asthma follow-up visits in primary care or specialty settings
Before adjusting controller therapy (step-up vs. step-down)
Monitoring response to initiation of new asthma medications (e.g., biologics)
Research and clinical trials involving asthma control endpoints
Identifying patients at high risk for future exacerbations despite acceptable symptom scores

Formula

AIRQ total score = sum of 10 items (0 = well controlled, higher = worse control) Impairment domain (items 1–7): Symptom frequency, nighttime symptoms, activity limitation, rescue inhaler use, work/school absenteeism, overall asthma control Risk domain (items 8–10): Emergency visit, oral corticosteroid burst, hospitalizations Total range: 0–10 0–3: Well controlled 4–6: Partially controlled 7–10: Not well controlled

Pearls & pitfalls

AIRQ separately scores impairment and risk domains — a patient may have low impairment but high risk (e.g., recent exacerbations despite few daily symptoms).
A score of ≥ 1 on the risk domain (items 8–10) warrants targeted discussion about exacerbation prevention.
The AIRQ correlates with forced expiratory volume (FEV1) and exhaled nitric oxide (FeNO) but provides additional prognostic information.
Minimum clinically important difference (MCID) for AIRQ is estimated at 1 point.
Patients with controlled impairment but uncontrolled risk (e.g., prior hospitalization) are candidates for biologics or intensified controller therapy.
AIRQ is available in validated formats for both adults and adolescents ≥ 12 years.

Next steps

Well-controlled (AIRQ score 0–3): Maintain current regimen; consider step-down if controlled for ≥ 3 months. Partially controlled (AIRQ 4–6): Review inhaler technique, adherence, environmental triggers; consider step-up. Not well controlled (AIRQ 7–10): Step-up therapy; ensure controller use; refer to asthma specialist if needed.

Evidence

Nathan RA et al. (J Allergy Clin Immunol Pract 2017) validated AIRQ in 1,205 adults and adolescents with asthma. Demonstrated high reliability (α = 0.87), good discriminant validity, and responsiveness to change. Aligned with NAEPP component scoring for both impairment and risk domains.

References

Nathan RA et al. The development and validation of a novel asthma questionnaire to assess impairment and risk: the Asthma Impairment and Risk Questionnaire. J Allergy Clin Immunol Pract. 2017;5(3):757-766. — link
Nathan RA et al. Correlation of the Asthma Impairment and Risk Questionnaire with established asthma outcomes. J Allergy Clin Immunol Pract. 2019;7(1):103-112. — link

Asthma Impairment and Risk Questionnaire (AIRQ)

Calculator