1. Validation of the ´Control of allergic rhinitis and asthma test´ (CARAT) 1-week version and app
Presenter: Corina de Jong PhD
Department of General Practice,
Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen,
The Netherlands

2. Conflict of interest No conflicts of interest
The study was funded by an unrestricted grant by AstraZeneca

3. Asthma and allergic rhinitis
The most prevalent asthma phenotype is allergic asthma with allergic rhinitis (AR)
70-90% of asthma patients also have AR
40-50% of AR patients also have asthma

4. Astma en allergische rinitis
The ‘Allergic Rhinitis and its Impact on Asthma’ (ARIA) initiative1, recommends concurrent evaluation and treatment of asthma and AR.
However, until recently no tool was available to measure both AR and asthma.
Prof. Fonseca designed the: Control of Allergic Rhinitis and Asthma Test (CARAT)2.
1: Bousquet J et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update. Allergy Suppl 86:8-160.
2: Nogueira-Silva et al .Control of allergic rhinitis and asthma test – a formal approach to
the development of a measuring tool. Resp. Res. 2009

5. The CARAT questionnaire
10 questions
Total score and 2 subdomains: AR (item 1 - 4) and asthma (item )
Covers a 4 week period
Validated in original language (Portuguese)
Translated and validated in Dutch3
3: van der Leeuw S et al. The minimal clinically important difference of the Control of Allergic Rhinitis and Asthma Test (CARAT); cross-cultural validation and relation with pollen counts.. Prim Care Respir Med 2015.

6. Validating the 1 week version Validating the digital CARAT-App
Aim of the study
Validating the 1 week version
Validating the digital CARAT-App

7. Study set-up
ARIA: Allergic Rhinitis and its Impact on Asthma – AR severity
VAS: Visual Analog Scale- Severity of general, upper and lower airway problems
GINA: Global Initiative for Asthma- Asthma severity
ACQ: Asthma Control Test- Asthma severity

8. Statistics plan Internal consistency  Cronbach’s alfa.
Hypotheses: Cronbach’s alfa >0.7. This is considered acceptable.
Test-retest reliability of the P&P and App Spearman correlation.
Hypotheses: all p<0.05. And r>0.5, meaning strong correlation.
4wkCARAT relation with 1wkCARAT  Wilcoxon-Signed-Rank.
Hypotheses: No significant difference.
Construct validity (using ACQ, VAS, GINA and ARIA)  spearman correlation and students T-test.
Hypotheses: Spearman correlation all p<0.05 and r>0.5.
Students T-test significant difference in CARAT between mild vs medium/severe rhinitis.
App satisfaction  percentages.

9. Demographics Total 109 participants Gender 39.4 % men Mean age
53 years
Median Packyears 11
Mean FEV1 % predicted
93.95

10. Results
Cronbach’s alpha>0.787 for all (sub)scales in both the P&P and the app version.
Hypotheses confirmed, good internal consistency
Test-retest reliability all p<0.001; r≥0.724 ≤ For both the P&P version and the app.
Hypotheses confirmed, good test-retest reliability
No significant difference between 4wkCARAT and 1wkCARAT, p=0.232.
Hypotheses confirmed
No significant difference in score between the P&P and the app version.

11. Results – Construct validity I
VAS
ACQ
GINA
General airway complaints
Nasal
complaints
Bronchial/pulmonary
CARAT
Correlation (P-value)
-0.625
0.000
-0.482
-0.574
-0.657
-0.554
CARAT, subscale rhinitis
-0.354
-0.569
-0.234
0.014
-0.318
0.001
-0.144
0.007
CARAT, subscale asthma
-0.661
-0.259
-0.695
-0.705
-0.670
Hypotheses confirmed, good construct validity

12. Results – Construct validity II
Difference in CARAT-rhinitis score between ARIA mild vs medium/severe rhinitis also significant: p=0.011.
Hypotheses confirmed.
App satisfaction:
84.4 % of patients found the app (very) easy to use.
41.3 % prefers the app, 4.6% paper, 54.1% liked both.

13. Conclusion The 1wk CARAT is valid and reliable
Both as pen & paper and as app version
Making it these useful tools for research and daily practice purposes