What tools are available for assessing the severity of asthma (bronchial asthma)?

From the Guidelines

The Asthma Control Test (ACT) is the most recommended tool for assessing asthma severity, as it provides a standardized and validated measure of asthma control. This questionnaire consists of five questions that evaluate symptoms, rescue inhaler use, and the impact of asthma on daily activities over the past four weeks, with a total score ranging from 5 to 25 1. The ACT has been validated against specialist’s rating of control and spirometry, and quality of life, with published cut-points for well-controlled asthma and poorly controlled asthma being greater than or equal to 20 and less than or equal to 15, respectively 1.

Some key points to consider when using the ACT include:

• The test is easy to use and can be completed on the internet or telephone 1
• A pediatric version (C-ACT) has been developed for children aged 4 to 11 years 1
• The ACT has been translated into more than 40 languages, but further research is required to ensure validity in different languages and practice settings 1
• The length, presentation, and ease of use of the ACT make it an attractive option as a self-assessment tool both in its paper and web-active versions 1

Other valuable assessment tools include:

• The Asthma Control Questionnaire (ACQ) 1
• Peak flow monitoring using a peak expiratory flow meter 1
• Spirometry testing (particularly FEV1 measurements) 1
• The Global Initiative for Asthma (GINA) classification system 1

These tools help clinicians objectively measure lung function, track symptom patterns, and determine appropriate treatment adjustments, with the goal of minimizing morbidity, mortality, and improving quality of life for patients with asthma 1. Regular assessment is crucial because asthma severity can fluctuate over time due to various triggers, seasonal changes, and treatment adherence issues, allowing for timely intervention before exacerbations become severe 1.

From the Research

Asthma Severity Assessment Tools

• The Asthma Control Test (ACT) is a reliable and valid tool for assessing asthma control in patients, as demonstrated by studies 2, 3.
• The ACT is a patient-based tool that consists of 5 items and has been shown to have good internal consistency reliability and discriminant validity 3.
• The ACT score has been correlated with other measures of asthma control, such as lung function, symptom-free days, and use of rescue medications 4.

Using the Asthma Control Test

• An ACT score of 19 or less has been shown to provide optimum balance of sensitivity and specificity for detecting uncontrolled asthma 2.
• The ACT can be used to identify patients with poorly controlled asthma and to monitor changes in asthma control over time 2, 3.
• The ACT has been compared to other measures of asthma control, such as the Asthma Control Questionnaire (ACQ), and has been shown to be a useful tool for assessing asthma control in clinical practice 4.

Limitations and Considerations

• While the ACT is a useful tool for assessing asthma control, it may not be superior to assessing rescue medication use alone for predicting the risk of severe asthma exacerbations 5.
• The ACT should be used in conjunction with other clinical measures, such as lung function tests and medical history, to get a comprehensive picture of a patient's asthma control 2, 3.
• The ACT has been validated in various patient populations, but its use in specific patient groups, such as children or patients with severe asthma, may require further evaluation 6.