What lies beyond Asthma Control Test: Suggestions for clinical practice

Area of Science:

• Pulmonology
• Allergy and Immunology
• Clinical Assessment

Background:

• The Asthma Control Test (ACT) validity is linked to the Global Initiative for Asthma (GINA) definition of control.
• ACT does not assess airway reversibility or inflammation, key asthma indicators partially independent of symptoms.
• The influence of rhinitis on ACT accuracy remains under-evaluated.

Purpose of the Study:

• To evaluate ACT validity using a comprehensive control definition including FEV1, reversibility, and FeNO.
• To assess the impact of rhinitis on ACT's reliability in asthma patients.

Main Methods:

• Studied 177 asthmatics using ACT, spirometry (FEV1), reversibility testing, and FeNO measurements.
• Analyzed ACT's predictive values and reliability using ROC curves across different rhinitis severities and asthma classifications.

Main Results:

• ACT demonstrated high positive predictive value (83.5%) but low sensitivity (47.8%) and NPV (26.5%).
• ACT was more reliable in mild intermittent rhinitis (AUC: 0.714) than in nasal polyposis/chronic rhino-sinusitis (AUC: 0.176).
• ACT was more likely to detect uncontrolled asthma in moderate persistent asthma (OR 5.464) than mild persistent asthma.

Conclusions:

• ACT, relying on self-reported outcomes, may not fully reflect airway inflammation or obstruction.
• Rhinitis presence and severity can influence ACT results, impacting its accuracy.
• Understanding factors affecting ACT is crucial, particularly in primary care where it's often the sole assessment tool.