Asthma Control Test and Asthma Control Questionnaire: factorial validity, reliability and correspondence in assessing status and change in asthma control

Abstract

ACT is a unidimensional measure, but factor structure of ACQ remains unclear. Correspondence between ACT and ACQ depends on the aim of the assessment. Including FEV1 in the assessment of asthma control level even lowers reliability of ACQ and concordance with ACT. Our results support GINA (2014) in conceptualizing FEV1 as a risk factor for poor asthma outcome instead of an indicator of level of asthma control.

Comparing Asthma Control Questionnaire (ACQ) and National Asthma Education and Prevention Program (NAEPP) asthma control criteria

“…The reduced 6-item version questionnaire has been found to be valid and yielded clinical results comparable to the full version. 9, 17 The validity of the questionnaire was established in children and adolescents 6 to 16 years of age. 18 The mean score of the six items was computed ranging from 0 to 6, with higher scores indicating a greater degree of uncontrolled asthma.…”

“…16 A reduced version of the ACQ without spirometry or peak expiratory flow rate testing was also found valid, and showed nearly perfect agreement with the full version ACQ with identical clinical results. 9, 17 …”

Relationship between the Asthma Control Test (ACT) and other outcomes: a targeted literature review

“…In total, seven publications reported ACT and Asthma Control Questionnaire (ACQ) data (Table 1) [8][9][10][11][12][13][14]. Six publications found strong and consistent correlations between improvement in ACT score and improvement in ACQ score [8][9][10][11][12][13], with five of the publications assessing the statistical significance of the correlations.…”

“…In total, seven publications reported ACT and Asthma Control Questionnaire (ACQ) data (Table 1) [8][9][10][11][12][13][14]. Six publications found strong and consistent correlations between improvement in ACT score and improvement in ACQ score [8][9][10][11][12][13], with five of the publications assessing the statistical significance of the correlations. All five of these reports found statistically significant Number of asthma exacerbations 10 2 26,27 (2) 26,27 8 17,22,23,28-32 (7) 22,23,[28][29][30][31][32] Lung function 17 8 3,15,27,33-37 (5 b ) 3,34-37 9 11,13,18,38-43 (7 b ) 11,13,[38][39][40]42,43 General HRQoL 7 0 (0) 7 [49][50][51][52][53][54][55] (5 b ) 49,50,[52][53][54] Asthma-related QoL 7 5 28,34,[44][45]…”

“…Publications that did not assess the significance were not taken into account for this calculation relationships between ACT and ACQ scores (p < 0.05) [8][9][10][11][12]. Schuler et al [12] reported that the ACQ-7 had a strong positive correlation, with a moderate correspondence with ACT score (Cohen's kappa κ = 0.56). Zhou et al [13] reported strong correlations between improvement in ACT score and improvement in both the ACQ-7 (all items) (Spearman correlation coefficient, r = − 0.687; robust correlation, r = − 0.865) and the ACQ-6 (excluding spirometry; Spearman correlation coefficient, r = − 0.491; robust correlation, r = − 0.637), although statistical significance was not tested.…”