Prospective evaluation of current asthma control using ACQ and ACT compared with GINA criteria

Background: The goal of asthma treatment is to achieve and maintain current best control and reduce future risk of exacerbations and long-term morbidity. Objective: To prospectively compare current asthma control as defined by ACQ (asthma control questionnaire) and ACT (asthma control test) criteria with the GINA (Global Initiative for Asthma) classification in treated patients in a real-life setting. Methods: In 150 adult patients (48% male, age 46.3 +/- 14.4 years., forced expiratory volume in 1 second [FEV1], 2.3 +/- 0.9 L or 78.5 +/- 21.8% pred.), asthma control was evaluated using the GINA classification as the "true" and ACQ-7, ACQ-5, and ACT as "predictor" criteria. The relationship between GINA-defined uncontrolled vs controlled/partly controlled asthma and ACQ and ACT scores was assessed with the ACQ cutpoint of >= 1.50 and the ACT cut-point of <= 19 for uncontrolled asthma. Results: The ACQ-7 and ACT correctly predicted GINA-defined uncontrolled asthma in 71.3% and 80.7% of patients, respectively. Sensitivity was high, with 88% for ACQ-7 and 94% for ACT, specificity was 57% and 70%, positive predictive value was 63% and 72%, and negative predictive value was 86% and 93%. Similar results were obtained using ACQ-5. ACQ-7 and ACT classified significantly more patients as having uncontrolled asthma compared with the GINA criteria (P < .001). Conclusions: ACQ scores >= 1.50 and ACT scores <= 19 are suitable to indicate uncontrolled asthma. To identify GINA-defined uncontrolled asthma, cutoff points for ACQ-5 should be >= 1.9 and for ACT <= 16, at least in real-life adult patients with mostly moderate and severe asthma. Ann Allergy Asthma Immunol. 2011;107:474-479.