"Turkish Validation and Reliability Study of the Brompton Breathing Pattern Assessment Tool in Asthma Patients"

This study is designed to assess the validity and reliability of the Turkish version of the Brompton Breathing Pattern Assessment Tool (BPAT). BPAT is a well-established tool used to assess the breathing patterns of individuals with respiratory conditions. In this study, a group of asthma patients will be evaluated using the BPAT to determine its applicability and consistency in the Turkish-speaking population.

The reliability of the tool will be tested through repeated measurements, and its validity will be assessed by comparing BPAT results with other validated asthma assessment tools. The data will be analyzed to evaluate the internal consistency, test-retest reliability, and construct validity of the BPAT in a clinical asthma population.

The linguistic validation process will be conducted following the ISPOR Task Force guidelines, including forward translation, reconciliation, back-translation, and cognitive debriefing. The psychometric properties of the tool, including internal consistency, test-retest reliability, and construct validity, will be evaluated according to the COSMIN checklist standards.

Additionally, participant eligibility will be defined as individuals who are diagnosed with asthma and can understand and respond to questions in Turkish. The study will also explore any cultural adaptations necessary for the Turkish version of the BPAT to ensure its cultural relevance and accuracy in assessments.

• Brompton Breathing Pattern Assessment Tool (BPAT) - Turkish Version (Other): A tool used to assess breathing patterns in asthma patients through clinical observation.
• Validation Battery (Nijmegen Questionnaire, Dyspnea-12, Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (Mini AQLQ), Spirometry) (Other): A set of validated questionnaires and objective tests used to compare with BPAT results for construct validity

Primary outcomes

• Construct Validity of the Turkish Version of the Brompton Breathing Pattern Assessment Tool (BPAT) [Baseline]: The study aims to evaluate the construct validity of the Turkish version of the BPAT in assessing breathing patterns among Turkish-speaking asthma patients. Validity will be determined by calculating correlation coefficients (e.g., Spearman's or Pearson's r) between the total BPAT scores, objective physiological measures (spirometry results such as FEV1 and FVC), and the scores of established reference clinical tools (Nijmegen Questionnaire, Dyspnea-12, Asthma Control Test (ACT), and Asthma Quality of Life Questionnaire (Mini-AQLQ).

Secondary outcomes

• Test-Retest Reliability of the Turkish Version of BPAT [7 to 14 days]: This outcome will assess the test-retest reliability of the Turkish version of BPAT by measuring the consistency of the tool in repeated assessments. The BPAT will be administered twice to the same participants. Reliability will be evaluated by calculating the Intraclass Correlation Coefficient (ICC).
• Inter-Rater Reliability of the Turkish Version of BPAT [Baseline]: This outcome will assess the inter-rater reliability of the Turkish version of BPAT. Two independent physiotherapists will evaluate the breathing pattern of the same asthma patient. The raters will be blinded to each other's scores to determine the consistency of the tool's application between different users. Reliability will be evaluated by calculating the Intraclass Correlation Coefficient (ICC) or Cohen's Kappa.
• Comparison of BPAT Results with Other Asthma Assessment Tools [Baseline]: Description: This outcome will compare the BPAT results with other validated asthma assessment tools, such as Nijmegen Questionnaire, Dyspnea-12 Questionnaire , spirometry, ACT (Asthma Control Test), and Mini AQLQ (Asthma Quality of Life Questionnaire), to determine the congruence between different assessment methods.

Sex: All, ages: 18 Years to 75 Years

Inclusion Criteria:

* Aged between 18 and 75 years
* Diagnosed with severe persistent asthma according to the Global Initiative for Asthma (GINA) criteria
* Turkish ethnicity
* Ability to read and write in Turkish
* Willingness to participate in the study

Exclusion Criteria:

* Having had a respiratory infection in the last 1 month
* Use of oral corticosteroids in the last 4 weeks
* Presence of malignancy, vasculitis, or pregnancy
* Body Mass Index (BMI) > 35 kg/m2
* Diagnosis of COPD or other primary respiratory diseases (excluding asthma)
* Any musculoskeletal, neurological, or cardiovascular condition that could interfere with breathing pattern assessment or impede potential respiratory physiotherapy applications

• Todd S, Walsted ES, Grillo L, Livingston R, Menzies-Gow A, Hull JH. Novel assessment tool to detect breathing pattern disorder in patients with refractory asthma. Respirology. 2018 Mar;23(3):284-290. doi: 10.1111/resp.13173. Epub 2017 Sep 14. PMID 28905471

• Zuhal Kunduracılar, Prof., Principal investigator, Istanbul Gelisim University
• Fatma M. Tepetam, Prof., Study chair, Saglik Bilimleri Universitesi
• Şeyma Ozden, Dr., Study chair, Saglik Bilimleri Universitesi
• Dilek Unsal, PT PhD(c), Principal investigator, Saglik Bilimleri Universitesi
• Nisanur Tutus, PT Phd (c), Study chair, Saglik Bilimleri Universitesi