title: Predictive Properties of the Asthma Control Test and Its Component Questions for Severe Asthma Exacerbations.
abstract: Current US guidelines recommend the Asthma Control Test (ACT) for assessing disease control and selecting treatment.
  
  
  
  The goal of this study was to prospectively assess the ACT and its component questions for their utility in predicting the risk of severe asthma exacerbations.
  
  
  
  Individuals were participants in the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity, and those included in the current analysis had the following characteristics: age 18 years or more, physician-diagnosed asthma, and longitudinal care received at a large health system in southeastern Michigan. Study participants underwent a baseline evaluation, which included answering the ACT. A severe asthma exacerbation was defined as one requiring oral steroids, an emergency department visit, or inpatient admission. Receiver-operator characteristic curves were used to measure and compare the predictive utility of the ACT and its component questions for severe asthma exacerbations.
  
  
  
  Of 1180 participants, 354 (30.0%) experienced a severe asthma exacerbation within 6 months of their baseline evaluation. When compared with the individual questions that composed the ACT, the composite score was significantly better at predicting severe exacerbations with 1 exception; the composite ACT score and the question assessing rescue medication use were not significantly different (P = .580). Pharmacy-based records of metered-dose inhaler short-acting beta-agonist use and asthma severity were also not significantly different from the composite ACT score.
  
  
  
  Our study demonstrates that although the ACT is modestly predictive for exacerbations, the composite score may not be superior to assessing rescue medication use alone for predicting the risk of severe asthma exacerbations.
authors.affiliation: Department of Internal Medicine, Henry Ford Health System, Detroit, Mich.
authors.forename: Sonia
authors.initials: S
authors.lastname: Cajigal
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Mich.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Wells
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Mich.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Peterson
authors.affiliation: Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Mich.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Ahmedani
authors.affiliation: School of Nursing, University of Michigan, Ann Arbor, Mich.
authors.forename: James J
authors.initials: JJ
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Bioengineering & Therapeutic Sciences, University of California San Francisco, San Francisco, Calif; Department of Medicine, University of California San Francisco, San Francisco, Calif.
authors.forename: Esteban G
authors.initials: EG
authors.lastname: Burchard
authors.affiliation: Department of Internal Medicine, Henry Ford Health System, Detroit, Mich; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Mich. Electronic address: kwillia5@hfhs.org.
authors.forename: L Keoki
authors.initials: LK
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
chemical_list: D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents
keywords: Asthma; Asthma Control Test; Asthma exacerbation; Asthma rescue medication; Bronchodilator agents; Short-acting beta-agonist