Assessment of Control of Bronchial Asthma in Children Using Childhood Asthma Control Test

Abstract

Background. The use of Childhood Asthma Control Test (C-ACT) has been advised for monitoring asthma control by the Global Initiative for Asthma (GINA) guidelines.Objective. To validate the tool C-ACT for the assessment of control of asthma and to examine the correlation between C-ACT score and lung function assessed by forced expiratory volume in one second (FEV 1 ).Methods. This was a prospective observational study conducted between January 2010 to January 2011. Children diagnosed to have bronchial asthma and aged 5 to 14 years, were enrolled in the study. Asthma severity and control status were classified according to the National Asthma Education and Prevention Programme (NAEPP) and GINA guidelines, respectively. Patients were followed-up at three and six months and C-ACT and spirometric measurements were obtained.Results. Significant positive correlations were found between C-ACT score and FEV 1 at enrollment (r=0.772) (p<0.001), three months (r=0.815) (p<0.001) and at six months follow-up (r=0.908) (p<0.001). Baseline C-ACT score was useful for predicting the levels of control of asthma upto three months (0.004), but not at six months follow-up (0.787). A cut-off C-ACT value of >19 had a sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) 98.5%, 89.1%, 94.9%, 96.6%, 0.717, respectively for the control of asthma. Conclusion.C-ACT is a simple and feasible tool to assess and predict the levels of control in children with bronchial asthma upto three months.

Validity of the Childhood Asthma Control Test in diverse populations: A systematic review

“…In addition to the original study by Liu et al 11 13 other studies identified a recommended cut‐off for uncontrolled asthma, ranging from ≤18 to ≤24 19,20,23,25–29,35,36,38,39,41 . Of these 13 studies, three recommended the original cut‐off of ≤19, 26,27,38 eight recommended a cut‐off higher than the original, 19,23,25,28,35,36,39,41 and two recommended a lower cut‐off of ≤18 20,29 .…”

“…Gender of the study participants ranged from 47% to 72% male, and participants ranged from 4 to 14.2 years old. Three studies included children outside of the C‐ACT's intended age range of 4–11, instead including ages 5–14, 27 4–12, 28 and 4–14.2 29…”

“…In addition to the original study by Liu et al 11 13 other studies identified a recommended cut-off for uncontrolled asthma, ranging from ≤18 to ≤24. 19,20,23,[25][26][27][28][29]35,36,38,39,41 Of these 13 studies, three recommended the original cut-off of ≤19, 26,27,38 eight recommended a cut-off higher than the original, 19,23,25,28,35,36,39,41 and two recommended a lower cutoff of ≤18. 20,29 When examining the studies by region, three of eight studies done in Asia, 23,25,28 two of four in the Middle East, 39,41 and two of eight in Europe 35,36 recommended a cut-off higher than ≤19.…”

“…Gender of the study participants ranged from 47% to 72% male, and participants ranged from 4 to 14.2 years old. Three studies included children outside of the C-ACT's intended age range of 4-11, instead including ages 5-14, 27 4-12, 28 and 4-14.2. 29 The most commonly reported types of validity studied were clinical validity (six studies), 11,18,19,29,36,37 construct validity (four studies), 11,21,36,42 and criterion validity (three studies) 22,38,42 (Table 2).…”

“…The included studies (Table 1) were published between 2007 and 2018. Of the 28 studies included, five were conducted in the United States, 11,[18][19][20][21] eight in Asia (East, South, or Southeast Asia), [23][24][25][26][27][28][29] eight in Europe, [30][31][32][33][34][35][36][37]44 four in the Middle East, [38][39][40][41] two in South America, 12,42 and one in Africa. 43 Twenty-two studies reported the language used to administer the C-ACT, and the languages varied.…”