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Integrated Therapeutics Group Child Asthma Short Form

Name of Questionnaire

Integrated Therapeutics Group Child Asthma Short Form


Disease-specific, self report functional health questionnaire designed for parents of chronic asthma patients ages 5 to 12 years; shortened version of a 17-item questionniare measuring symptoms and disability in pediatric asthma patients developed by Usherwood et al. (1990). 1


Original survey developed by TP Usherwood, A Scrimgeour and JH Barber 1 ; short form developed by DA Bukstein, MM McGrath, DA Buchner, J Landgraf, and TF Goss.


Don A. Bukstein, MD
Dean Medical Center
1313 Fish Hatchery Road
Madison, WI 53715



Self administered by parent of patient

Number of items


Domains & categories

3 domains

Name of categories/domains

Daytime symptoms (2 items), Nighttime symptoms (2 items), Functional limitations (4 items)

Scaling of items

5-point Likert-type scale: all of the time, most of the time, some of the time, a little of the time, none of the time


Items within scales are summed and linearly transformed from 0 to 100, with higher scores indicating better functioning


a. Test-retest/reproducibility 2
b. Internal consistency 2




Original: English


  1. Usherwood TP, Scrimgeour A, Barber JH. Questionnaire to measure perceived symptoms and disability in asthma. Archives of Disease in Childhood 1990;65:779-781.
  2. Bukstein DA, McGrath MM, Buchnew DA, Landgraf J, Goss TF. Evaluation of a short form for measuring health-related quality of life among pediatric asthma patients. J Allergy Clin Immunol 2000;105:245-51.

Date of information

February 2001

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