Development of the Asthma Control TEST. A survey for assessing asthma control
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.
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.
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.
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 FEV(1) (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.
Results reinforce the usefulness of a brief, easy to administer, patient-based index of asthma control.
Available from: Enrico Heffler
- "Therefore, the total ACT score is between 5 and 25, with a lower score standing for poorer controlled asthma. An ACT score 19 reflects uncontrolled asthma, values between 20 and 24 partially controlled asthma, while a score of 25 means complete asthma control. "
- "The level of asthma control was evaluated according to the recommendations of the GINA report, designed and standardised by the Nathan Asthma Control Test (ACT™)[2,21]. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT "
Available from: Carlos Melero Moreno
- "Also, patients completed the TAI instrument (19). Clinical asthma control was assessed with the Asthma Control Test (ACT) (20,21) (an ACT score 20 identified well-controlled asthma patients), and COPD clinical status was evaluated with the COPD Assessment Test (CAT) (22) (CAT < 10 identified low impact COPD patients). Spirometry was performed according to the European Respiratory Society/American Thoracic Society guidelines (23) using the predicted values for Mediterranean population (24). "
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ABSTRACT: Differences between COPD and asthma may also differentially affect adherence to inhaled drugs in each disease. We aimed to determine differences in behaviour patterns of adherence and non-adherence to inhaled therapy between patients with COPD and patients with asthma using the Test of Adherence to Inhalers (TAI) questionnaire. A total of 910 patients (55% with asthma, 45% with COPD) participated in a cross-sectional multicentre study. Data recorded included sociodemographics, education level, asthma or COPD history, TAI score, the Asthma Control Test (ACT), the COPD Assessment Test (CAT) and spirometry. Asthma patients were statistically significant less adherents, 140 (28%) vs. 201 (49%), and the pattern of non-adherence was more frequently erratic (66.8% vs. 47.8%) and deliberate (47.2% vs. 34.1%) than COPD patients; however unwitting non-adherence was more frequently observed in COPD group (31.2% vs. 22.8%). Moreover, taking together all sample studied, only being younger than 50 years of age (OR 1.88 [95% CI: 1.26-2.81]) and active working status (OR 1.45 [95% CI: 1.00-2.09]) were risk factors for non-adherence in the multivariate analysis, while having asthma remained in the limits of the significance (OR 1.44 [95%CI: 0.97-2.14]). Even though non-adherence to inhalers is more frequently observed in asthma than in COPD patients and exhibited a different non-adherence patterns, these differences are more likely to be related to sociodemographic characteristics. However, differences in non-adherence patterns should be considered when designing specific education programmes tailored to each disease.
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