Asthma, Rhinitis, Other Respiratory Diseases
Development of the asthma control test: A survey for assessing asthma control

https://doi.org/10.1016/j.jaci.2003.09.008Get rights and content

Abstract

Background

Asthma guidelines indicate that the goal of treatment should be optimum asthma control. In a busy clinic practice with limited time and resources, there is need for a simple method for assessing asthma control with or without lung function testing.

Objectives

The objective of this article was to describe the development of the Asthma Control Test (ACT), a patient-based tool for identifying patients with poorly controlled asthma.

Methods

A 22-item survey was administered to 471 patients with asthma in the offices of asthma specialists. The specialist's rating of asthma control after spirometry was also collected. Stepwise regression methods were used to select a subset of items that showed the greatest discriminant validity in relation to the specialist's rating of asthma control. Internal consistency reliability was computed, and discriminant validity tests were conducted for ACT scale scores. The performance of ACT was investigated by using logistic regression methods and receiver operating characteristic analyses.

Results

Five items were selected from regression analyses. The internal consistency reliability of the 5-item ACT scale was 0.84. ACT scale scores discriminated between groups of patients differing in the specialist's rating of asthma control (F = 34.5, P < .00001), the need for change in patient's therapy (F = 40.3, P < .00001), and percent predicted FEV1 (F = 4.3, P = .0052). As a screening tool, the overall agreement between ACT and the specialist's rating ranged from 71% to 78% depending on the cut points used, and the area under the receiver operating characteristic curve was 0.77.

Conclusion

Results reinforce the usefulness of a brief, easy to administer, patient-based index of asthma control.

Section snippets

Working groups and survey development

A working group composed of primary care clinicians (n = 4) and of leading asthma specialists (n = 7) was convened to advise on the development of a tool for assessing control. The working group participants represented a range of geographic regions in the United States. The working group helped to specify the components of asthma control that should be assessed by the survey and participated in defining a criterion measure of asthma control that would be used in evaluating the survey's

Sample

Four hundred seventy-one patients completed the survey. Of the 471 respondents, 407 (86.4%) completed all 22 survey items. The average age of respondents was 45.2 years (SD, 18.5) with a range of 12 to 94 years. Approximately 14% of the sample was age 65 years or older, and 12% were younger than 20 years of age. The majority of the sample had asthma that was well controlled (52.2%) or completely controlled (18.1%) according to the specialist's rating of asthma control. The mean percent

Discussion

The 5 items empirically selected for the ACT survey parallel the dimensions of asthma control that underlie current asthma management guidelines—asthma symptoms, use of rescue medications, and the impact of asthma on everyday functioning—and support the premise that asthma control is a multidimensional construct. In this study, scores computed from ACT were shown to be reliable and valid, and the test as a whole shows promising ability to screen for patients with poorly controlled asthma.

Two of

Acknowledgments

We would like to acknowledge Sidney S. Braman, MD, Brown University School of Medicine, Douglas C. Cline, MD, Broadway Family Practice & Trenton Family Practice, Matthew L. Mintz, MD, George Washington University Medical Center, Russell J. T. Perry, MD, New York Medical College, and Maureen George, MSN, RN, CS, University of Pennsylvania Health System for their participation as part of the working group. We would also like to thank Richard Stanford, PharmD, MS, Priti Jhingran, PhD, Debbie

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