Evaluation of the Asthma Control Test; a reliable determinant of disease stability and a predictor of future exacerbations.
Summary of "Evaluation of the Asthma Control Test; a reliable determinant of disease stability and a predictor of future exacerbations."
SUMMARY AT A
GLANCE:
Single, but not serial, measurement of ACT is useful for assessing asthma control, prediction of exacerbation and changes in treatment decisions.
ABSTRACT:
Background and Objective: This study assessed the asthma control test (ACT) cut-off values for asthma control according to the GINA guideline in adults and the effectiveness of ACT scores in predicting exacerbations and serial changes in ACT scores over time in relation to treatment decisions. Methods: Subjects completed ACT together with same-day spirometry and fractional concentration of exhaled nitric oxide (FeNO) measurement at baseline and at 3 months. Physicians, blinded to the ACT scores and FeNO values, assessed the patient's asthma control in the past month and adjusted the asthma medications according to management guidelines. Asthma exacerbations and urgent healthcare utilization (HCU) at 6 months were recorded. Results: 379 (120men) asthmatics completed the study. The ACT cut-off for uncontrolled and partly controlled asthma were ≤19 (sensitivity 0.74, specificity 0.67, % correctly classified 69.5) and ≤22 respectively (sensitivity 0.73, specificity 0.71, % correctly classified 72.1). Baseline ACT score had an odds ratio of 2.34 (95%CI 1.48-3.69) and 2.66 (1.70-4.18) for urgent HCU and exacerbations respectively at 6 months (p < 0.0001). However, baseline FeNO and spirometry values had no association with urgent HCU and exacerbations. The 3-month ACT score of ≤20 correlated best with step-up of asthma medications (sensitivity 0.65, specificity 0.81, % correctly classified 72.8). For serial changes of ACT scores over 3 months, the cutoff value was best at ≤3 for treatment decisions with low sensitivity (0.23) and % correctly classified (57.3%) values. Conclusions: Single measurement of ACT is useful for assessing asthma control, prediction of exacerbation and changes in treatment decisions.
Affiliation
Department of Medicine and Therapeutics, Department of Pediatrics, The Chinese University of Hong Kong.
Journal Details
This article was published in the following journal.
Name: Respirology (Carlton, Vic.)
ISSN: 1440-1843
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22107482
- DOI: http://dx.doi.org/10.1111/j.1440-1843.2011.02105.x
Medical and Biotech [MESH] Definitions
Diagnostic Test Approval
The process of gaining approval by a government regulatory agency for DIAGNOSTIC REAGENTS AND TEST KITS. This includes any required preclinical or clinical testing, review, submission, and evaluation of the applications and test results, and post-marketing surveillance.
Disease Progression
The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis.
Randomized Controlled Trials As Topic
Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.
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Work consisting of a clinical trial that involves at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.
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Work consisting of a clinical trial involving one or more test treatments, at least one control treatment, specified outcome measures for evaluating the studied intervention, and a bias-free method for assigning patients to the test treatment. The treatment may be drugs, devices, or procedures studied for diagnostic, therapeutic, or prophylactic effectiveness. Control measures include placebos, active medicine, no-treatment, dosage forms and regimens, historical comparisons, etc. When randomization using mathematical techniques, such as the use of a random numbers table, is employed to assign patients to test or control treatments, the trial is characterized as a RANDOMIZED CONTROLLED TRIAL.
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