The Asthma Control Test (ACT) as a predictor of GINA guideline-defined asthma control: analysis of a multinational cross-sectional survey

Abstract

Aims: To evaluate whether the Asthma Control Test (ACT) score is predictive of Global Initiative for Asthma (GINA) guideline-defined classification levels of asthma control. The ACT is a validated, 5-item, patient-completed measure of asthma control with a recall period of four weeks.

Methods: Cross-sectional survey comparing ACT score and GINA classification of asthma control among 2949 patients attending primary care physicians and specialists in France, Germany, Italy, Spain, the UK, and the USA.

Results: The area under the receiver operating characteristics curve for ACT score predicting GINA control was 0.84 (95% CI 0.82-0.85). An ACT score of <19 (not well-controlled asthma) correctly predicted GINA-defined partly controlled/uncontrolled asthma 94% of the time, while an ACT score of >20 predicted GINA-defined controlled asthma 51% of the time, with kappa statistic of 0.42, representing moderate agreement.

Conclusions: An ACT score <19 is useful for identifying patients with poorly controlled asthma as defined by GINA.

Conflict of interest statement

Elizabeth V Hillyer has received freelance writing assignments from Merck and Aerocrine. She has no shares in any pharmaceutical company. Professor David Price has consultant arrangements with: Altana, Boehringer-Ingelheim, GlaxoSmithKline, Ivax and Pfizer. He or his team have received grants and research support for research in respiratory disease from the following organisations: UK National Health Service, Altana Pharma, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Ivax, Merck Sharpe and Dohme, Novartis, Pfizer, and Schering Plough. Professor Price has also spoken for: Altana Pharma, Boehringer-Ingelheim, GlaxoSmithKline, Merck, Sharpe and Dohme and Pfizer. Angela E. Williams and Jacqueline R Carranza Rosenzweig are employees of GlaxoSmithKline.