What are the Asthma Control Test (ACT) questions?

From the Guidelines

The Asthma Control Test (ACT) is a widely used and validated questionnaire for assessing asthma control, consisting of five questions with a total score ranging from 5 to 25, where a score of 20 or above indicates well-controlled asthma. The ACT questions evaluate symptoms over the past month, including shortness of breath, night-time waking, interference with activity, rescue bronchodilator use, and patient rating of asthma control 1. Each item is scored using a 1–5 scale, and the test is easy to use, with options for completion on the internet or telephone 1.

Key Components of the ACT

• The test has been validated against specialist’s rating of control and spirometry, as well as quality of life 1
• A pediatric version, the C-ACT, is available for children aged 4 to 11 years, with a score range of 0–27 1
• Published cut-points for well-controlled asthma and poorly controlled asthma are greater than or equal to 20 and less than or equal to 15, respectively 1

Clinical Application

• The ACT is useful for healthcare providers to make treatment decisions, such as adjusting medication regimens based on asthma control 1
• Patients should complete the ACT at regular intervals, typically every 3-6 months, to track their asthma control over time and guide management decisions 1
• A change in ACT score of 1.88 corresponds to a change of one level in physician rating of asthma control, highlighting the test's sensitivity to changes in asthma control 1

From the Research

Asthma Control Test Questions

• The Asthma Control Test (ACT) is a patient-based tool for identifying patients with poorly controlled asthma, with internal consistency reliability of 0.85 and test-retest reliability of 0.77 2.
• The ACT has criterion validity, 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) 2.
• The ACT is responsive to changes in asthma control and lung function, 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) 2.
• An ACT score of 19 or less provides optimum balance of sensitivity (71%) and specificity (71%) for detecting uncontrolled asthma 2.
• The development of the ACT involved a 22-item survey administered to 471 patients with asthma, with stepwise regression methods used to select a subset of items that showed the greatest discriminant validity in relation to the specialist's rating of asthma control 3.
• The internal consistency reliability of the 5-item ACT scale was 0.84, and ACT scale scores discriminated between groups of patients differing in the specialist's rating of asthma control, the need for change in patient's therapy, and percent predicted FEV(1) 3.
• The ACT has been compared to other instruments, such as the Asthma Control Questionnaire (ACQ), with the ACQ shown to be a valid and reliable instrument for assessing asthma control 4.
• A prospective analysis compared the ACT to the new Subjective Asthma Questionnaire (SAQ-1) for assessing asthma control, finding correlations between the ACT and SAQ-1 scores, and excellent sensitivity and specificity for assessing not well-controlled asthma with the SAQ-1 5.
• A systematic review and meta-analysis compared the diagnostic performances of the ACT and ACQ, finding that the ACT had good diagnostic accuracy for assessment of controlled and not well-controlled asthma, while the ACQ had good diagnostic accuracy for assessment of not well-controlled asthma at prespecified cutoff points 6.