Asthma control test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists
Abstract
Background The development of the Asthma Control Test (ACT), a short, simple, patient-based tool for identifying patients with poorly controlled asthma, was recently described in patients under the routine care of an asthma specialist.Objectives We sought to evaluate the reliability and validity of the ACT in a longitudinal study of asthmatic patients new to the care of an asthma specialist.Methods Patients (n=313) completed the ACT and the Asthma Control Questionnaire (ACQ) at 2 physician visits (4-12 weeks apart). Pulmonary function was measured, and asthma specialists rated asthma control.Results Internal consistency reliability of the ACT was 0.85 (baseline) and 0.79 (follow-up). Test-retest reliability was 0.77. Criterion validity was demonstrated by significant correlations between baseline ACT scores and baseline specialists' ratings of asthma control (r=0.52, P<.001) and ACQ scores (r=-0.89, P<.001). Discriminant validity was demonstrated, with significant (P<.001) differences in mean ACT scores across patients differing in asthma control, pulmonary function, and treatment recommendation. Responsiveness of the ACT to changes in asthma control and lung function was demonstrated with significant correlations between changes in ACT scores and changes in specialists' ratings (r=0.44, P<.001), ACQ scores (r=-0.69, P<.001), and percent predicted FEV1 values (r=0.29, P<.001). An ACT score of 19 or less provided optimum balance of sensitivity (71%) and specificity (71%) for detecting uncontrolled asthma.Conclusions The ACT is reliable, valid, and responsive to changes in asthma control over time in patients new to the care of asthma specialists. A cutoff score of 19 or less identifies patients with poorly controlled asthma.Clinical implications In a clinical setting the ACT should be a useful tool to help physicians identify patients with uncontrolled asthma and facilitate their ability to follow patients' progress with treatment.
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The ACT is an often used scale with good psychometric properties.
“It is an often used scale with good psychometric properties (Schatz et al., 2006).”
From Targeting excessive avoidance behavior to reduce anxiety related to asthma: A feasibility study of an exposure-based treatment delivered online (2021) · cites this paper as Schatz et al., 2006
ACT has shown good internal consistency (Cronbach's alpha = 0.84) and is acceptable to specify degree of asthma severity.
“ACT has shown good internal consistency (Cronbach's alpha = 0.84) and is acceptable to specify degree of asthma severity (Schatz, Sorkness, Li et al., 2006).”
From Exposure‐based cognitive behavior therapy for anxiety related to asthma: A feasibility study with multivariate baseline design. (2020) · cites this paper as Schatz, Sorkness, Li et al., 2006
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- Authors
- Schatz, M., Sorkness, C. A., Li, J. T., Marcus, P., Murray, J. J., Nathan, R. A., Kosinski, M., Pendergraft, T. B., & Jhingran, P.
- Affiliations
- Kaiser Permanente (US)
- University of Wisconsin–Madison (US)
- Mayo Clinic (US)
- Vanderbilt University (US)
- Corresponding author
- Schatz, Michael
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 2006-03
- Volume
- 117
- Issue
- 3
- Pages
- 549-556
- ISSN
- 0091-6749 (ISSN-L)
- OpenAlex
- W2086332783
- Cited by
- 1,221
- References
- 17
- Citations by year
- 2026: 55 · 2025: 58 · 2024: 61 · 2023: 58 · 2022: 89 · 2021: 89 · 2020: 92 · 2019: 95 · 2018: 69 · 2017: 73 · 2016: 73 · 2015: 46 · 2014: 57 · 2013: 66 · 2012: 48
- FWCI
- 20.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Keywords
- Asthma Control Test, asthma control, patient-reported outcome measures, Asthma Control Questionnaire, reliability statistics, validity, responsiveness, uncontrolled asthma, lung function, FEV1, cut-off values
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Asthma, Child, Humans, Longitudinal Studies, Mass Screening, Middle Aged, Surveys and Questionnaires, Respiratory Function Tests, Severity of Illness Index, Reproducibility of Results
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