The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analysis

doi:10.1016/j.jaci.2012.08.023

Journal of Allergy and Clinical Immunology

Volume 131, Issue 3, March 2013, Pages 695-703

https://doi.org/10.1016/j.jaci.2012.08.023 Get rights and content

Background

Currently, the cornerstone of asthma management is the achievement and maintenance of optimal asthma control, but the diagnostic performances of the Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) have not been evaluated systematically.

Objective

We explored the diagnostic performances of and statistically compared the ACT and ACQ.

Methods

Studies that examined the accuracy of the ACT, ACQ, or both in the assessment of asthma control were found by searching PubMed, CENTRAL, Web of Science, Ovid, and Embase. Summary estimates of sensitivity, specificity, and diagnostic odds ratios for the different levels of asthma control were determined by using bivariate random-effects models and hierarchical summary receiver operating characteristic models.

Results

Twenty-one studies with 11,141 subjects assessed with the ACT and 12,483 assessed with the ACQ were identified. The ACT had good diagnostic accuracy for assessment of controlled and not well-controlled asthma, and the ACQ (ACQ-7 and ACQ-6) had good diagnostic accuracy for assessment of not well-controlled asthma at prespecified cutoff points. The ACT and ACQ had significant differences in the assessment of controlled and not well-controlled asthma after adjusting for potential factors (P = .001 and P = .015). For assessment of uncontrolled asthma, the ACT had poor accuracy, with a hierarchical summary receiver operating characteristic area under the curve of 0.69, and the cutoff point for the ACQ has not been established.

Conclusion

The ACT is preferable to the ACQ in clinical practice, and the ACQ requires further cross-validation. Moreover, neither the ACT nor the ACQ is useful for the assessment of uncontrolled asthma.

Section snippets

Search strategy and selection criteria

Electronic databases, including PubMed (1998 to December 2011), CENTRAL (Cochrane Controlled Trials Register, issue 1, 2012), Web of Science (1998 to December 2011), Ovid (1998 to December 2011), and Embase (1998 to December 2011), were searched for relevant articles. Details are provided in the Methods section in this article’s Online Repository at www.jacionline.org.

Data extraction

The following details were extracted from each included article: authors, year of publication, study population, settings, race

Included studies

Our search strategy initially yielded 1607 citations (Fig 1). Of these, 21 eligible trials that used the ACT (n = 12), the ACQ (n = 6), or both (n = 3) to assess asthma control were included in our study.4, 6, 7, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39 One was a poster abstract, and 2 were real-world studies.

Study characteristics and quality of reporting

Table II and Tables E2 to E5 and Fig E1 (available in this article’s Online Repository at www.jacionline.org) show the characteristics and quality of

Discussion

To our knowledge, this is the first study to systematically explore the diagnostic performances of the ACT and ACQ in assessments of levels of asthma control and to provide comparative analyses. Our study suggests that the ACT provided a good diagnostic accuracy for assessments of controlled and not well-controlled asthma and that the ACQ (ACQ-7 and ACQ-6) accurately assessed not well-controlled asthma at prespecified cutoff points. However, the sensitivity and specificity of the ACQ were in a

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: Supported by the National Natural Science Foundation of China (30971326 and 30901907), the Sichuan Youth Science and Technology Foundation (2010JQ0008), and Youth Science Funding of Sichuan University (2011SCU04B17).

: Disclosure of potential conflict of interest: G. Wang has received grants from the National Natural Science Foundation of China, the Sichuan Youth Science and Technology Foundation, Youth Science Funding of Sichuan University; and has received an APSR Research/Training Fellowship (2011) and a scholarship as visiting Associated Professor at the University of Newcastle, Australia. The rest of the authors declare that they have no relevant conflicts of interest.

^∗: These authors contributed equally to this work.

View full text

Asthma and lower airway diseaseThe Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analysis

Background

Objective

Methods

Results

Conclusion

Section snippets

Search strategy and selection criteria

Data extraction

Included studies

Study characteristics and quality of reporting

Discussion

An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice

Am J Respir Crit Care Med

Expert Panel Report: guidelines for the diagnosis and management of asthma update on selected topics—2002

J Allergy Clin Immunol

Development of the asthma control test: a survey for assessing asthma control

J Allergy Clin Immunol

Development and validation of a questionnaire to measure asthma control

Eur Respir J

Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists

J Allergy Clin Immunol

Identifying “well-controlled” and “not well-controlled” asthma using the Asthma Control Questionnaire

Respir Med

The minimally importance difference of the Asthma Control Test

J Allergy Clin Immunol

Asthma outcomes: composite scores of asthma control

J Allergy Clin Immunol

III Consenso Brasileiro no Manejo da Asma 2002

J Pneumol

Current asthma control predicts future risk of asthma exacerbation: a 12-month prospective cohort study

Chin Med J (Engl)

Use of the Asthma Control Questionnaire to predict future risk of asthma exacerbation

J Allergy Clin Immunol

QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies

Ann Intern Med

Discrepancy between clinical asthma control assessment tools and fractional exhaled nitric oxide

Ann Allergy Asthma Immunol

Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews

J Clin Epidemiol

Bivariate random effects meta-analysis of ROC curves

Med Decis Making

Uptake of newer methodological developments and the deployment of meta-analysis in diagnostic test research: a systematic review

BMC Med Res Methodol

Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests

BMJ

Summary receiver operating characteristic curve analysis techniques in the evaluation of diagnostic tests

Ann Thorac Surg

A hierarchiacal regression approach to meta-analysis of diagnostic test accuracy evaluations

Stat Med

The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed

J Clin Epidemiol

Validation of the Spanish version of the Asthma Control Test (ACT)

J Asthma

Asthma and lower airway disease
The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analysis