title: Relationship between asthma control status, the Asthma Control Test™ and urgent health-care utilization in Asia.
abstract: OBJECTIVE
  Accurate assessment of control is an integral part of asthma management. We investigated the relationship between control status derived from the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT) and urgent health-care utilization.
  
  
  METHODS
  Asthma Insights and Reality in Asia-Pacific Phase 2 (AIRIAP 2) was a cross-sectional, community-based survey of 4805 subjects with asthma from urban centres across Asia. A symptom control index was derived from the AIRIAP 2 questionnaire using the GINA control criteria for day- and night-time symptoms, need for rescue medication, activity limitation and exacerbations; lung function was excluded. The main outcomes were asthma control, based on these GINA criteria and the ACT, and the relationship between control and self-reported urgent health-care utilization (hospitalization, emergency room visits or other unscheduled urgent visits) related to asthma over the previous 12months.
  
  
  RESULTS
  Each of the symptom criteria was significantly associated with urgent health-care utilization, with odds ratios (ORs) ranging from 2.25 (95% confidence interval (CI): 1.94-2.61) for daytime symptoms to 2.57 (95% CI: 2.29-2.90) for nocturnal awakening. Similarly, control status was significantly associated with urgent health-care utilization, with ORs of 0.19 (95% CI: 0.13-0.28), 0.70 (95% CI: 0.65-0.76) and 1.00 for controlled, partly controlled and uncontrolled, respectively. The optimal ACT cut-off score for identifying uncontrolled asthma was ≤19 for subjects aged ≥12years. Urgent health-care utilization was reported by 57.2% versus 28.7% of patients scoring ≤19 versus >19 (P<0.001).
  
  
  CONCLUSIONS
  The GINA control classification and the ACT are valid symptom-based measures that are significantly associated with urgent health-care utilization.
authors.affiliation: The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, Singapore. keilai@netvigator.com
authors.forename: Christopher K W
authors.initials: CK
authors.lastname: Lai
authors.forename: Fanny W S
authors.initials: FW
authors.lastname: Ko
authors.forename: Arvind
authors.initials: A
authors.lastname: Bhome
authors.forename: Teresita S
authors.initials: TS
authors.lastname: DE Guia
authors.forename: Gary W K
authors.initials: GW
authors.lastname: Wong
authors.forename: Bin M Z
authors.initials: BM
authors.lastname: Zainudin
authors.forename: An N
authors.initials: AN
authors.lastname: Nang
authors.forename: Watchara
authors.initials: W
authors.lastname: Boonsawat
authors.forename: Sang H
authors.initials: SH
authors.lastname: Cho
authors.forename: Kirthi D
authors.initials: KD
authors.lastname: Gunasekera
authors.forename: Jian G
authors.initials: JG
authors.lastname: Hong
authors.forename: Jeng-Yuan
authors.initials: JY
authors.lastname: Hsu
authors.forename: Nhung N
authors.initials: NN
authors.lastname: Viet
authors.forename: Faisal
authors.initials: F
authors.lastname: Yunus
authors.forename: Amartya
authors.initials: A
authors.lastname: Mukhopadhyay
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001208:Asia; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome