title: Cut points for Asthma Control Tests in Mexican children in Orange County, California.
abstract: BACKGROUND
  The Childhood Asthma Control Test (C-ACT) and the Asthma Control Test (ACT) are validated measures of asthma control in which a score of 19 is defined as uncontrolled according to published reports. However, different cut points may exist in different ethnic populations.
  
  
  OBJECTIVE
  To determine the cut point for uncontrolled asthma in a Mexican descent population from Orange Country, California, compared with an age- and asthma severity-matched non-Hispanic cohort.
  
  
  METHODS
  The C-ACT (in children 6-11 years old) and ACT (in children 12-17 years old) scores were collected from 151 children of Mexican descent and 48 non-Hispanic controls with mild-to-moderate asthma who lived in Orange County. Physicians were masked to C-ACT and ACT scores while assessing control based on National Asthma Education and Prevention program guidelines. The receiver operating characteristic method was used to examine the screening accuracy of the tests to detect uncontrolled asthma. The optimal cut points were selected by maximizing the total sensitivity and specificity.
  
  
  RESULTS
  Cronbach α values for the C-ACT (0.76) and the ACT (0.80) confirmed that both tests were reliable in our study population. The C-ACT and ACT scores were statistically higher in children of Mexican descent than non-Hispanic children (P = .008). A cut point of 22 was optimal to detect uncontrolled asthma in children of Mexican descent 6 to 11 years old (group 1: sensitivity, 0.74; specificity, 0.86; area under the curve [AUC], 0.83) and children 12 to 17 years old (group 3: sensitivity, 0.78; specificity, 0.68; AUC, 0.79). For non-Hispanic controls, a cut point of 20 were optimal to detect uncontrolled asthma in children 6 to 11 years old (group 2: sensitivity, 0.70; specificity, 0.91; AUC, 0.86) and children 12 to 17 years old (group 4: sensitivity, 0.83; specificity, 0.87; AUC, 0.91).
  
  
  CONCLUSIONS
  In this cross-ethnic validation study, children of Mexican descent in Orange County seem to underreport asthma symptoms compared with a non-Hispanic population and may require higher C-ACT and ACT cut points to detect uncontrolled asthma.
authors: Department of Biomedical Engineering, University of California, Irvine, California, USA.
authors: Yixin
authors: Y
authors: Shi
authors: Ahramahzd V
authors: AV
authors: Tatavoosian
authors: Anna S
authors: AS
authors: Aledia
authors: Steven C
authors: SC
authors: George
authors: Stanley P
authors: SP
authors: Galant
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D017058:Mexican Americans / Q000706:statistics & numerical data; D012015:Reference Standards; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index