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The Asthma Trigger Inventory: Validation of a Questionnaire for Perceived Triggers of Asthma

From the Department of Psychology, Southern Methodist University, Dallas, Texas (T.R.); The Department of Epidemiology and Public Health, University College of London, London, U.K. (A.S.); StaRNet, St. George’s Hospital Medical School, University of London, U.K. (C.B.); the Center for Health Care Evaluation, Department of Veterans Affairs Health Care System, Palo Alto, California (A.H.S.H.); and Jenner Health Centre, Forest Hill, London, U.K. (M.E.).

Address correspondence and reprint requests to Thomas Ritz, PhD, Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442. E-mail: tritz{at}smu.edu

Background: Asthma patients’ perceptions of triggers have been explored in a largely unstructured fashion in the past. We therefore developed and validated a questionnaire of commonly perceived asthma triggers.

Methods: Two hundred forty-seven primary care patients with asthma filled in an asthma trigger survey together with questionnaires on demographics, asthma-relevant information, perceived control of asthma, and general health status. Factor structure of the item pool and psychometric properties of trigger subscales were evaluated. We also investigated the relationship between allergen or psychological trigger reports and allergy skin test response or respiratory impedance during emotional film viewing, respectively.

Results: Principal component analysis yielded six factors that were thematically associated with psychology, animal allergens, pollen allergens, physical activity, infection, and air pollution/irritants. Subscales showed good internal consistencies and low to moderately positive intercorrelations. Psychological triggers were consistently associated with less favorable health status, a reduced perception of asthma control, and greater medical treatment utilization. Animal allergen scores correlated positively with skin test responses to animal allergens. Respiratory impedance increases during emotional film clips were positively correlated with the psychological trigger subscale.

Conclusion: The questionnaire is a reliable measure of commonly perceived asthma triggers. Aspects of patients’ trigger reports reflect actual reactivity to specific trigger factors.

Key Words: asthma • psychological factors • illness perception • asthma triggers • primary care • allergy skin testing • questionnaire

Abbreviations: ATI = Asthma Trigger Inventory; BTS = British Thoracic Society; PCAQ = Perceived Control of Asthma Questionnaire; SF-36 = Short Form 36 Health Survey.

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