Validation of the Arabic version of the asthma control test
H. Lababidi, A. Hijaoui1, M. Zarzour1
Department of Critical Care, King Fahad Medical City, Riyadh, Saudi Arabia. 1 Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
Abstract: PURPOSE: Asthma control test (ACT) has been devised to assess the degree of asthma control in out-patientssetting. The aim of this study is to validate the Arabic version of ACT. MATERIALS AND METHODS: Patients completed the Arabic version of ACT during regular visit to one of two asthma specialists. Spirometry was obtained. The asthma specialist rated asthma control using a 5-point scale and indicated modiﬁcation in management as step up, same or step down of asthma treatment. RESULTS: 40 patients completedthe study, the mean age was 32.6 + 14.0 years, mean FEV1 was 2.7 + 1.0 L (89.2% + 23.6% of predicted). The mean ACT score was 15.9 + 5.8; mean of specialist asthma control rating was 3.4 + 1.0. The internal consistency reliability of the 5-item ACT survey was alpha = 0.92. The correlation was moderate between ACT and specialists rating (r = 0.482, P = 0.002) and between ACT and treatmentmodiﬁcation (r = –0.350, P = 0.027). The correlation between FEV1 and ACT was low (r = 0.185, P = 0.259). ACT distinguished between patients with different specialist rating (F = 3.37, P = 0.02) and the need to change therapy (F = 3.62, P = 0.037). The areas under the curve (ROC) for ACT, FEV1, and ACT and FEV1 as independent variables were 0.720, 0.721, and 0.766 respectively. All results were comparableto the initial work for development of ACT. CONCLUSION: The Arabic version of the ACT is a valid tool to assess asthma control. ACT correlates better with asthma specialist rating of asthma control than with FEV1. Key words: Asthma, asthma assessment, asthma control test
Correspondence to: Dr. Hani MS Lababidi, Department of Critical Care, King Fahad Medical City, Riyadh, Saudi Arabia. E-mail:hlababidi@ kfmc.med.sa Submission: 18-09-07 Accepted: 28-02-08
sthma is a clinical diagnosis made by physicians on the basis of patient’s medical history, physical examination, assessment of the reversibility of airway obstruction, and exclusion of alternative diagnosis that mimic asthma. Asthma is a very common disease with immense social impact. The global prevalence of asthma rangesfrom 1% to 18%.  The improved understanding of the pathophysiology underlying asthma and the emergence of medications to prevent acute exacerbations more effectively have led clinicians to shift their focus from managing acute attack to achieving asthma control. According to international guidelines, the primary goal of asthma management is to achieve and maintain asthma control deﬁned as ‘nodaytime symptoms, no limitations of daily activities, no nocturnal symptoms or awakening, no need for reliever treatment, normal or near-normal lung function results and no exacerbations.’ Based on results of large multinational, community-based surveys of asthma showing that the majority of patients have an alarmingly high rate of symptoms and disruption of life from their disease, one cansay that this goal has not been achieved. Asthma control can be difficult to assess in clinical practice because of its multidimensional nature and variability over time. Tools that are easily and quickly administered in clinical practice are required in order to develop an
accurate, quick, and practical asthma control test. Thus, the need for a simple method for quantifying asthma controlby both patients and physicians has brought up the development of a short assessment tool called the asthma control test (ACT). This tool is a ﬁve-item questionnaire developed as an easy method for patients and clinicians to assess symptoms, use of rescue medications, and impact on activities. Each question is graded from one to ﬁve. The score range is 5 to 25. Well-controlled asthma is...
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