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

The goal of asthma treatment is to achieve and maintain current best control and reduce future risk of exacerbations and long-term morbidity.

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.

In 150 adult patients (48% male, age 46.3 ± 14.4 years., forced expiratory volume in 1 second [FEV(1)], 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.

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).

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.