Severe Asthma Questionnaire (SAQ)

The team

This project is a collaborative effort between the University of Plymouth’s Faculty of Health: Medicine, Dentistry and Human Sciences, the School of Psychology, and University Hospitals Plymouth NHS Trust. The team consists of Professor Michael Hyland, Professor Rupert Jones, Joseph Lanario, Lucy Cartwright, Dr Yinghui Wei and Dr Matthew Masoli, who is the clinical lead for asthma at the Royal Devon and Exeter Hospital and has established a regional severe/difficult asthma service.


The quality of life of patients with severe asthma differs from mild and moderate asthma, partly because of a greater burden of symptoms and risk of exacerbations, but also due to differences in treatment, which can have more pronounced side effects. Existing asthma-specific Health-Related Quality of Life (HRQoL) scales are not optimally designed for severe asthma patients.

Why is a new questionnaire needed?

Existing questionnaires are not valid for assessing quality of life in severe asthma, according to the 2009 guidelines on questionnaire construction provided by the Federal Drug and Food Administration (FDA). This is because these questionnaires fail to address some of the quality of life deficits experienced by this group of patients.

How did we develop the SAQ?

Three studies were carried out to create a valid HRQoL measure in accordance with FDA guidelines. First, we conducted a series of qualitative interviews with patients diagnosed with severe asthma. These interviews concerned factors affecting a patient’s HRQoL, including asthma symptoms and medication side effects. The qualitative data from this study showed that many of the burdens experienced by this patients group were not assessed by the asthma-specific HRQoL questionnaires available at the time (1).

A draft SAQ was then made using the information gained from the interviews. Relevant questions for a severe asthma-specific questionnaire were chosen for this draft. This draft SAQ was evaluated in four focus groups by patients diagnosed with severe asthma, and iterative changes were made after each group. Participants were encouraged to suggest changes to the questionnaires in order to improve its comprehensibility and relevance to the experience of severe asthma (2).

The final step was a quantitative assessment of the SAQ, using data from 160 patients diagnosed with severe asthma. This was the final step in the FDA’s stepwise process of validation of a severe asthma quality of life questionnaire.

One of our published papers (3) provides data that validates the use of the SAQ in clinical practice and in clinical trials of severe asthma.

A multi-centre study collecting data on the SAQ is currently underway. This data will be used to further assess the psychometric properties of the questionnaire, assess sensitivity to change and determine its minimum clinically important difference (MCID).

The group developing the questionnaire have also investigated the similarities between severe asthma and functional disorders such as fibromyalgia (4) and published theoretical work on the reasons for individual differences in response to biologic treatments for severe asthma (5).


1. Hyland ME, Whalley B, Jones RC, Masoli M. A qualitative study of the impact of severe asthma and its treatment showing that treatment burden is neglected in existing asthma assessment scales. Qual Life Res. 2015;24(3):631–9.

2. Hyland ME, Lanario JW, Pooler J, Masoli M, Jones RC. How patient participation was used to develop a questionnaire that is fit for purpose for assessing quality of life in severe asthma. Health Qual Life Outcomes. 2018;16(1):1–9.

3. Hyland ME, Jones RC, Lanario JW, Masoli M. The construction and validation of the Severe Asthma Questionnaire. Eur Respir J. 2018;52(1):1800618.

4. Hyland M, Lanario J, Wei, Y, Jones R, Masoli M. Evidence for similarity in symptoms and mechanism: the extra-pulmonary symptoms of severe asthma and polysymptomatic presentation of fibromyalgia. Immunity, Inflammation and Disease. 2019: In press.

5. Hyland M, Masoli M, Lanario J, Jones R. A possible explanation for non-responders, responders and super-responders to biologics in severe asthma. Exploratory Research and Hypothesis in Medicine. 2019: In press.

The SAQ is available for clinical use, clinical trials, and registries. 

To download the questionnaire and for more details, please go to:  @SAQPlymouth