Nathan Robert A, Sorkness Christine A, Kosinski Mark, Schatz Michael, Li James T, Marcus Philip, Murray John J, Pendergraft Trudy B
Asthma and allergy Associates and Research Center, Colorado Springs, USA.
J Allergy Clin Immunol. 2004 Jan;113(1):59-65. doi: 10.1016/j.jaci.2003.09.008.
Asthma guidelines indicate that the goal of treatment should be optimum asthma control. In a busy clinic practice with limited time and resources, there is need for a simple method for assessing asthma control with or without lung function testing.
The objective of this article was to describe the development of the Asthma Control Test (ACT), a patient-based tool for identifying patients with poorly controlled asthma.
A 22-item survey was administered to 471 patients with asthma in the offices of asthma specialists. The specialist's rating of asthma control after spirometry was also collected. Stepwise regression methods were used to select a subset of items that showed the greatest discriminant validity in relation to the specialist's rating of asthma control. Internal consistency reliability was computed, and discriminant validity tests were conducted for ACT scale scores. The performance of ACT was investigated by using logistic regression methods and receiver operating characteristic analyses.
Five items were selected from regression analyses. The internal consistency reliability of the 5-item ACT scale was 0.84. ACT scale scores discriminated between groups of patients differing in the specialist's rating of asthma control (F = 34.5, P <.00001), the need for change in patient's therapy (F = 40.3, P <.00001), and percent predicted FEV(1) (F = 4.3, P =.0052). As a screening tool, the overall agreement between ACT and the specialist's rating ranged from 71% to 78% depending on the cut points used, and the area under the receiver operating characteristic curve was 0.77.
Results reinforce the usefulness of a brief, easy to administer, patient-based index of asthma control.
哮喘治疗指南指出，治疗目标应为实现最佳哮喘控制。在时间和资源有限的繁忙门诊实践中，需要一种简单的方法来评估哮喘控制情况，无论是否进行肺功能测试。
本文旨在描述哮喘控制测试（ACT）的开发过程，这是一种基于患者的工具，用于识别哮喘控制不佳的患者。
对471名哮喘患者在哮喘专科医生办公室进行了一项包含22个条目的调查。同时收集了专科医生在进行肺功能测定后对哮喘控制情况的评分。采用逐步回归方法选择一组与专科医生哮喘控制评分具有最大判别效度的条目。计算内部一致性信度，并对ACT量表得分进行判别效度测试。采用逻辑回归方法和受试者工作特征分析来研究ACT的性能。
从回归分析中选择了5个条目。5条目ACT量表的内部一致性信度为0.84。ACT量表得分能够区分专科医生哮喘控制评分不同的患者组（F = 34.5，P <.00001）、患者治疗方案改变的必要性（F = 40.3，P <.00001）以及预测FEV(1)百分比（F = 4.3，P =.0052）。作为一种筛查工具，根据所使用的切点不同，ACT与专科医生评分之间的总体一致性在71%至78%之间，受试者工作特征曲线下面积为0.77。
结果证实了一种简短、易于实施、基于患者的哮喘控制指标的有用性。
