9th April 2010, Volume 123 Number 1312

Shaun Holt

Asthma is a common and chronic disease, affecting around 1 in 6 New Zealanders and causing the third largest number of years lost to disability.1Unlike many other chronic diseases such as high blood pressure or raised cholesterol, there is no simple test or score by which asthma control can be assessed and monitored. Instead, a combination of different questions and assessments, such as peak flow readings and questions about reliever use, are used by health professionals.

The Asthma Control Test (ACT) and Childhood Asthma Control Test are recently validated questionnaires that are completed by the patient and parents/caregivers.2–4 They consist of 5 simple questions, resulting in a score between 5 and 25, and the questions can be completed in less than a minute. A score of 20 or above indicates well or completely controlled asthma, 15-19 indicates somewhat controlled asthma and a score of 14 or less identifies patients with poorly or uncontrolled asthma.

These questionnaires have been clinically validated by specialist assessment and spirometry and are recognized by the National Institutes of Health. Around 80% of patients with asthma in New Zealand have uncontrolled asthma, yet most of these patients think that their asthma is well controlled.5,6 By having a single score that the health professional and patient can monitor, it is hoped that it will be easier to identify patients with suboptiomal asthma control and outcomes will improve.

As part of a recent fund-raising activity, Asthma NZ held mobile asthma clinics for free asthma education for 4 hours each day in 9 New Zealand cities from Christchurch to Auckland on consecutive days in March 2010. Anyone with asthma could attend the clinic and the Asthma Control Test and Childhood Asthma Control Test were completed as part of the educational activities.

Although this was not a controlled study the data collected provides an interesting snapshot of asthma symptoms in patients with asthma who attended the sessions and illustrates the usefulness of the Asthma Control Tests in quickly identifying patients whose asthma could be better controlled.

125 adults and parents/caregivers completed the ACT questionnaires. There were 70 males and 55 females, with a mean age of 38 (range 2-86). 88 participants self-identified as European, 27 as Maori, 3 as Asian and 3 as Pacific Islander.

The mean ACT score was 17.7 (range 6-25), with a distribution of:
ACT score
Level of control
N (%)
<15
poorly or uncontrolled asthma
36 (28.8%)
15-19
somewhat controlled asthma
35 (28%)
>19
well or completely controlled asthma
54 (43.2%)

Therefore this uncontrolled survey using a validated questionnaire found that around 57% of self-selected patients with asthma had asthma that was not well or completely controlled. The Asthma Control Test is simple and quick to complete and may become a standard part of asthma management.

Shaun Holt
Clinicanz, Tauranga

Author Information

Shaun Holt, Clinicanz, Tauranga

References

  1. Holt S, Beasley R. The burden of asthma in New Zealand. Published by Asthma and Respiratory Foundation of New Zealand, 2002. ISBN 086471095X
  2. US Department of Health and Human Services, National Institutes of Health, National Heart, Lung and Blood Institute. Expert Panel Report Guidelines for the Diagnosis and Management of Asthma (EPR-3 2007). NIH Item No. 08-4051.http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
  3. Nathan RA et al. Development of the asthma control test: A survey for assessing asthma control. J Allergy Clin Immunol. 2004;113:59-65.
  4. Liu A et al. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol. 2007;119:817-825.
  5. POMS Steering Committee. Asthma morbidity, control and treatment in New Zealand: results of the Patient Outcomes Management Survey (POMS), 2001. New Zealand Medical Journal 16 May 2003; 116.
  6. Holt S. NZ INSPIRE study. Research Review, 2007. http://www.researchreview.co.nz/NZ%20Inspire%20Report.pdf