Evaluation of asthma control using Global Initiative for Asthma criteria and the Asthma Control Test in Uganda

Abstract

Setting: Chest clinic of a national referral hospital in a resource-limited country.

Objectives: To determine the level of asthma control, factors influencing asthma control and the accuracy of the Asthma Control Test (ACT).

Design: We collected demographic and clinical data and administered the Global Initiative for Asthma (GINA) criteria test and the ACT. The proportions of patients in each of the GINA and ACT control categories (uncontrolled, partly controlled and well controlled) were calculated. Multivariate analysis was performed to identify factors associated with asthma control. Diagnostic test parameters for the ACT using GINA criteria as gold standard were calculated.

Results: Of 88 asthma patients enrolled, 67% were female. The median age was 34 years (range 12-85). Using GINA criteria, respectively 59 (67%), 17 (19%) and 12 (14%) patients had uncontrolled, partly controlled and well controlled asthma; per ACT, the corresponding figures were respectively 40% (35/88), 43% (38/88) and 17% (15/88). ACT sensitivity, specificity, positive predictive and negative predictive value were respectively 95%, 92%, 99% and 73%. Nasal congestion was associated with uncontrolled asthma (P = 0.031).

Conclusion: The majority of the patients at the Mulago Hospital have inadequately controlled asthma, and this is associated with nasal congestion. A simple symptom questionnaire, the ACT, can correctly classify asthma control.