Asthma diagnosis and treatment
Development and cross-sectional validation of the Childhood Asthma Control Test

https://doi.org/10.1016/j.jaci.2006.12.662Get rights and content

Background

For children younger than 12 years old with asthma, there are several quality-of-life instruments, clinical diaries, and questionnaires assessing symptoms; however, a validated tool for assessing asthma control is currently lacking.

Objective

To develop and validate the Childhood Asthma Control Test (C-ACT), a self-administered tool for identifying children aged 4-11 years whose asthma is inadequately controlled.

Methods

A 21-item questionnaire was administered to 343 patients with asthma and their caregivers, randomly assigning 75% (n = 257) for development and cross-sectional validation of the tool and 25% (n = 86) to a confirmatory sample. Stepwise logistic regression was used to reduce the 21 items to those best able to discriminate control as defined by the specialist's rating of asthma control.

Results

Seven items were selected from regression analyses of the development sample to comprise the C-ACT. The scores of each item were summed for a total score (0-27), with lower scores indicating poorer control. Summed scores discriminated between groups of patients differing in the specialists' rating of asthma control (F = 36.89; P < .0001), the need for change in patients' therapy (F = 20.07; P < .0001), and % predicted FEV1 (F = 2.66; P = .0494). A score of 19 indicated inadequately controlled asthma (specificity 74%, sensitivity 68%). These analyses were confirmed in the confirmatory sample.

Conclusion

The C-ACT is a validated tool to assess asthma control and identify children with inadequately controlled asthma.

Clinical implications

The C-ACT can be valuable in clinical practice and research based on its validation, ease of use, input from the child and caregiver, and alignment with asthma guidelines.

Section snippets

Development of the working questionnaire

The initial conceptual framework of domains for “asthma control” was developed from the national NAEPP1 guidelines, the international GINA2 guidelines, and working group input (10 childhood asthma and allergy specialists). To support this framework and determine further concepts, the literature was reviewed for existing generic and asthma-specific questionnaires as well as relevant literature for developing age-appropriate questions for younger children with asthma.13, 19, 20, 21, 22, 23, 24, 25

Results

The sample characteristics of the children (n = 343) are presented in Table I. The mean age was 8.1 years; 61% were male; and 74.34% were in “good to very good” health based on parent/caregiver report. Approximately 63% of caregivers had a college or graduate degree and about 63% were employed either part or full time. Specialists characterized 62% of the participants with mild, 36% with moderate, and 2% with severe asthma. Specialists concluded that 70.5% of their patients had asthma that was

Discussion

The cross-sectional validation of the C-ACT demonstrates the reliability and predictive properties of the tool to assess asthma control in children 4-11 years of age. The tool shows good ROC characteristics relative to the specialists' ratings of asthma control, as well as good performance of C-ACT scores in their ability to discriminate based on various levels of clinical variables, including spirometry and specialist's recommendation of a change in therapy. In addition, correlation of the

References (33)

  • C. Eiser et al.

    Quality-of-life measures in chronic diseases of childhood

    Health Technol Assess

    (2001)
  • G.K. Fritz et al.

    Patterns of response to childhood asthma

    Psychosom Med

    (1989)
  • M. Townsend et al.

    Evaluation of the burden of illness for pediatric asthmatic patients and their parents

    Ann Allergy

    (1991)
  • M. Lara et al.

    Differences between child and parent reports of symptoms among latino children with asthma

    Pediatrics

    (1998)
  • G.H. Guyatt et al.

    Children and adult perceptions of childhood asthma

    Pediatrics

    (1997)
  • Children and asthma in America. Available at: http://www.asthmainamerica.com. Accessed: November 30,...
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    Supported by GlaxoSmithKline.

    Disclosure of potential conflict of interest: A. H. Liu has consulting arrangements with GlaxoSmithKline, AstraZeneca, and Schering-Plough; has received grant support from GlaxoSmithKline, Microlife, Ross, and Novartis; and is on the speakers' bureau for GlaxoSmithKline, Merck, Schering-Plough, and AstraZeneca. R. Zeiger has consulting arrangements with Aerocrine, AstraZeneca, Dynavax, Genentech, GlaxoSmithKline, Merck, and Novartis; has received grant support from AstraZeneca, GlaxoSmithKline, Merck, Sanofi-Aventis, and Teva Pharmaceuticals; and has lectured for AstraZeneca. C. Sorkness has consulting arrangements with AstraZeneca and GlaxoSmithKline; has received grant support from GlaxoSmithKline; and is on the speakers' bureaus for GlaxoSmithKline. T. Mahr has received grant support from GlaxoSmithKline, Alcon, AstraZeneca, and Novartis and is on the speakers' bureau for Alcon, AstraZeneca, GlaxoSmithKline, Merck, Schering-Plough, Novartis, Genentech, Verus, and Sanofi-Aventis. N. Ostrom has received grant support from Alcon, Allux, Altana, AstraZeneca, Clay-Park Labs, Critical Therapeutics, Genentech, GlaxoSmithKline, Hoffman-LaRoche, Medicinova, MedPointe, Merck, Novartis, Pharmaxis, Rigel, Sanofi-Aventis, Schering-Plough, and Wyeth; has consulting arrangements with Aperon Biosystems, AstraZeneca, Genentech, and Verus Pharmaceuticals; and is on the speakers' bureau for AstraZeneca, Genentech, Novartis, GlaxoSmithKline, IVAX, KOS, Pfizer, Sanofi-Aventis, and Schering-Plough. S. Burgess has received grant support from GlaxoSmithKline. J. C. Rosenzweig and R. Manjunath are employed by GlaxoSmithKline.

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