Departments of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Respirology. 2012 Feb;17(2):370-8. doi: 10.1111/j.1440-1843.2011.02105.x.
This study assessed the asthma control test (ACT) cut-off values for asthma control according to the Global Initiative for Asthma guideline in adults and the effectiveness of ACT scores in predicting exacerbations and serial changes in ACT scores over time in relation to treatment decisions.
Subjects completed ACT together with same-day spirometry and fractional concentration of exhaled nitric oxide (FeNO) measurement at baseline and at 3 months. Physicians, blinded to the ACT scores and FeNO values, assessed the patient's asthma control in the past month and adjusted the asthma medications according to management guidelines. Asthma exacerbations and urgent health-care utilization (HCU) at 6 months were recorded.
Three hundred seventy-nine (120 men) asthmatics completed the study. The ACT cut-off for uncontrolled and partly controlled asthma were ≤19 (sensitivity 0.74, specificity 0.67, % correctly classified 69.5) and ≤22, respectively (sensitivity 0.73, specificity 0.71, % correctly classified 72.1). Baseline ACT score had an odds ratio of 2.34 (95% confidence interval: 1.48-3.69) and 2.66 (1.70-4.18) for urgent HCU and exacerbations, respectively, at 6 months (P < 0.0001). However, baseline FeNO and spirometry values had no association with urgent HCU and exacerbations. The 3-month ACT score of ≤20 correlated best with step-up of asthma medications (sensitivity 0.65, specificity 0.81, % correctly classified 72.8). For serial changes of ACT scores over 3 months, the cut-off value was best at ≤3 for treatment decisions with low sensitivity (0.23) and % correctly classified (57.3%) values.
Single measurement of ACT is useful for assessing asthma control, prediction of exacerbation and changes in treatment decisions.
本研究评估了成人哮喘全球倡议指南中哮喘控制测试（ACT）的截断值，以及 ACT 评分在预测 6 个月时哮喘恶化和 ACT 评分随时间变化方面的有效性，以评估治疗决策。
受试者在基线和 3 个月时同时完成 ACT 以及当日的肺活量测定和呼出一氧化氮（FeNO）浓度测定。医生根据管理指南，在不知道 ACT 评分和 FeNO 值的情况下，评估患者过去一个月的哮喘控制情况，并调整哮喘药物。记录 6 个月时的哮喘恶化和紧急医疗保健利用（HCU）。
379 名（120 名男性）哮喘患者完成了研究。未控制和部分控制哮喘的 ACT 截断值分别为≤19（敏感性 0.74，特异性 0.67，分类正确率为 69.5%）和≤22（敏感性 0.73，特异性 0.71，分类正确率为 72.1%）。基线 ACT 评分与 6 个月时的紧急 HCU 和恶化分别具有 2.34（95%置信区间：1.48-3.69）和 2.66（1.70-4.18）的优势比（P<0.0001）。然而，基线 FeNO 和肺活量值与紧急 HCU 和恶化无关。3 个月时的 ACT 评分≤20 与哮喘药物升级最相关（敏感性 0.65，特异性 0.81，分类正确率为 72.8%）。对于 3 个月内 ACT 评分的变化，最佳截断值为≤3，治疗决策的敏感性较低（0.23），分类正确率（57.3%）。
单次测量 ACT 可用于评估哮喘控制、预测恶化和改变治疗决策。
