Aims: To evaluate whether the Asthma Control Test TM (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.

BackgroundAs more inhaled corticosteroid (ICS) devices become available, there may be pressure for health-care providers to switch patients with asthma to cheaper inhaler devices. Our objective was to evaluate impact on asthma control of inhaler device switching without an accompanying consultation in general practice.MethodsThis 2-year retrospective matched cohort study used the UK General Practice Research Database to identify practices where ICS devices were changed without a consultation for ≥5 patients within 3 months. Patients 6–65 years of age from these practices whose ICS device was switched were individually matched with patients using the same ICS device who were not switched. Asthma control over 12 months after the switch was assessed using a composite measure including short-acting β-agonist and oral corticosteroid use, hospitalizations, and subsequent changes to therapy.ResultsA total of 824 patients from 55 practices had a device switch and could be matched. Over half (53%) of device switches were from dry powder to metered-dose inhalers. Fewer patients in switched than matched cohort experienced successful treatment based on the composite measure (20% vs. 34%) and more experienced unsuccessful treatment (51% vs. 38%). After adjusting for possible baseline confounding factors, the odds ratio for treatment success in the switched cohort compared with controls was 0.29 (95% confidence interval [CI], 0.19 to 0.44; p < 0.001) and for unsuccessful treatment was 1.92 (95% CI, 1.47 to 2.56; p < 0.001).ConclusionSwitching ICS devices without a consultation was associated with worsened asthma control and is therefore inadvisable.

No abstract

These qualitative interviews highlight the need to maintain clear and open communication with patients. Switching of patients' inhalers without their consent may diminish the self-control associated with good asthma management, leave the doctor-patient relationship damaged, increase resource utilisation, and waste medication.

The present authors explored the relationship between asthma control status, as measured by a derived Asthma Control Test TM (ACT) score, and the utilisation and cost of healthcare in Europe. Data were derived from a European survey of asthma patients. Frequency of healthcare resource use was identified from the dataset and per-patient mean cost of asthma management estimated. Drug costs were not available. The ACT score was derived from questions in the survey identical or similar to the items comprising the ACT.An ACT score was derived for 2,268 patients, of whom 48% (1,078) scored ,20, suggesting their asthma was not well controlled, with 17% (381) scoring ,15, suggesting poorly controlled asthma. The mean per-patient annual cost of asthma management for patients with a derived ACT of ,15 was J1,604 (95% confidence interval: J1,219-2,084); for patients with a derived ACT score of 15-19, J512 (J404-660) and for patients with a derived ACT score of o20, J232 (J192-286). A higher derived ACT score was associated with significantly lower expenditure on asthma management.Worse asthma control, as measured by the derived Asthma Control Test TM score was associated with an increased requirement for unscheduled care and with higher cost.KEYWORDS: Asthma, asthma control, Europe, healthcare costs A sthma is a chronic inflammatory respiratory disease and is a major cause of morbidity [1]. The prevalence of asthma in Western Europe ranges from 3.9% in Germany to 10.9% in the UK [2]. International guidelines recommend that the aim of asthma management should be to achieve and maintain control [3,4]. The Global Initiative for Asthma (GINA) guidelines define control as minimal (ideally no) chronic symptoms, minimal (infrequent) exacerbations, no emergency visits, minimal (ideally no) need for rescue medications, no activity restriction, peak expiratory flow (PEF) circadian variation ,20%, (near) normal PEF and minimal (or no) adverse effects from medicine [4].However, no consensus exists on the optimum method to assess asthma control in practice. Composite measures used for assessing asthma control include the Asthma Control Questionnaire [5], which has recently been validated in a shortened format that does not require the assessment of lung function [6], and the Asthma Control Test TM (ACT) [7]. The ACT is a reliable and valid patient-completed measure of asthma control that was developed for easy use in a clinical setting [7]. The ACT comprises five items, each relating to an aspect of asthma control over the previous 4 weeks: limitations to activities; shortness of breath; night-time awakening; use of rescue medication and patient perception of control. Completion of the ACT results in a score between 5 and 25, with a higher score indicating better control. A validation study found that an ACT score of o20 indicated ''well-controlled'' asthma, and a score of ,15 ''poorly controlled '' asthma [8]. The ACT has been shown to have a good specificity and sensitivity in identifying patients whose asthma control woul...

Lung function does not appear to be a valid criterion for assigning COPD management directed at patients with recurrent exacerbation.

Exacerbations of chronic obstructive pulmonary disease (COPD) have serious health consequences for patients and are strongly associated with unscheduled healthcare resource use. This study used a preference-based quality of life measure questionnaire (EQ-5D) to evaluate the impact of exacerbation on health status and utility during a patient's admission to hospital and short-term follow-up. Costs of admission were calculated. In total, 149 patients consented to take part in the study representing 222 admissions to hospital. At admission patients reported high levels of problems for all dimensions of the EQ-5D. Mean utility (-0.077) and Visual Analogue Scale (25.9) values indicated great impairment, with 61% of patients having a negative utility value representing a health state equivalent to 'worse than death' at admission. Many problems were still reported at discharge. By 3 months follow-up patients had deteriorated, with percentages of patients reporting problems in mobility (98%) and usual activity (88%) almost back up to admission levels. Health status and utility values were similar regardless of lung function at admission and at discharge. Approximately half of the patients in each category had a negative utility value at admission representing a health state 'worse than death', with similar levels of improvement by discharge. The mean cost of an admission was 2130.34 pounds (SD 1326.09) with only a mean of 110.37 pounds(5%) because of medication. No differences were noted by lung function category. In conclusion, all COPD patients requiring admission for an exacerbation suffer a serious deterioration in health status which, although improves during admission, notably deteriorates by 3 months postdischarge.

The substantial morbidity caused by asthma suggests that the disease is associated with a large economic burden. The current study analysed the burden of asthma in eight countries in the Asia-Pacific region.Responses to questions regarding resource use from a survey of people with asthma were analysed. Unit costs were obtained for each resource use element. Individual patient costs were estimated and means calculated for each country. A multivariate model was developed to identify potential predictors of resource use.Annual per-patient direct costs ranged from US$108 for Malaysia to US$1,010 for Hong Kong. When productivity costs were included, total per-patient societal costs ranged from US$184 in Vietnam to US$1,189 in Hong Kong. Urgent care costs were responsible for 18-90% of total perpatient direct costs. Overall, total per-patient direct costs were equivalent to 13% of per capita gross domestic product and 300% of per capita healthcare spending. Extremes of age, greater severity of asthma, and poorer general health status were predictive of high cost.The per-patient cost of asthma in these countries is high, particularly when seen in the context of overall per-patient healthcare spending. Strategies to improve asthma control are likely to not only improve patient outcomes, but also to decrease societal costs.