Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug 15;19(1):152.
doi: 10.1186/s12931-018-0858-0.

Age and African-American race impact the validity and reliability of the asthma control test in persistent asthmatics

Allison J Burbank  1   2 , Krista Todoric  3 , Pamela Steele  4 , Jonathan Rosen  5 , Haibo Zhou  5 , Marcia Frye  6 , Ceila E Loughlin  7 , Sally Ivins  8 , Katherine Mills  8 , Lauren Dembnicki Massey  9 , Bryce B Reeve  10 , Michelle L Hernandez  4
Affiliations

Age and African-American race impact the validity and reliability of the asthma control test in persistent asthmatics

Allison J Burbank et al. Respir Res. .

Abstract

Background: The Asthma Control Test (ACT) is widely used to assess asthma control, yet the validity and reliability of the test have not been specifically evaluated in adolescents or African-Americans. We conducted a prospective psychometric study of the ACT in African-American (AA) and non-African-American (nAA) adolescents with persistent asthma, with emphasis on the clinical utility of the test for medical decision making.

Methods: Participants completed the ACT and performed spirometry. A physician conducted a guidelines-based assessment of asthma control, blinded to the ACT score. Study procedures were repeated 6-8 weeks later. The ACT-based asthma control assessment was compared to physician assessment.

Results: For baseline and follow-up visits, internal consistency, as measured using Cronbach's alpha, was 0.80 and 0.81 in AA teens and 0.80 and 0.83 in nAA teens. Intraclass correlation coefficients were 0.59 and 0.76 in AA and nAA teens, respectively, with stable asthma control over time. Agreement between ACT and physician assessment was moderate in AA teens and fair in nAA teens. An ACT score of ≤19 showed reduced sensitivity for not well controlled asthma in both groups, while a score of ≤21 had the greatest area under the ROC curve. ACT scores were marginally responsive to change in control status.

Conclusions: Concerns for the ACT's ability to detect uncontrolled asthma in adolescents emphasizes the need for a more comprehensive evaluation of asthma control in clinical settings. A higher threshold ACT score to define not well controlled asthma may be needed if the ACT is to be used for medical decision making.

Trial registration: ClinicalTrials.gov: NCT02671643 , NCT02662413 .

Keywords: Adolescent; African-American; Asthma; Control; Questionnaire; Reliability; The asthma control test (ACT); Validity.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and was approved by the University of North Carolina’s Biomedical Institutional Review Board (#14–1532, #15–1804). Written informed consent and assent were obtained from participating children and their guardians.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Receiver operating characteristic (ROC) curves generated from ACT scores from the first study visit for AA and nAA teens indicate a score of ≤21 achieved the optimal balance of sensitivity and specificity for detection of not well controlled asthma and the largest area under the ROC curve
See this image and copyright information in PMC

References

    1. Moorman JE, Rudd RA, Johnson CA, King M, Minor P, Bailey C, et al. National surveillance for asthma--United States, 1980-2004. MMWR Surveill Summ. 2007;56(8):1–54. - PubMed
    1. Akinbami LJ, Moorman JE, Bailey C, Zahran HS, King M, Johnson CA, et al. Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief. 2012;(94):1–8. - PubMed
    1. Silvers SK, Lang DM. Asthma in African Americans: what can we do about the higher rates of disease? Cleve Clin J Med. 2012;79(3):193–201. doi: 10.3949/ccjm.79a.11016. - DOI - PubMed
    1. Mayrides MRL. Ethnic disparities in the burden and treatment of asthma. Washington, DC: Asthma and Allergy Foundation of America and National Pharmaceutical Council; 2005. pp. 1–60.
    1. Velsor-Friedrich B, Militello LK, Richards MH, Harrison PR, Gross IM, Romero E, et al. Effects of coping-skills training in low-income urban African-American adolescents with asthma. J Asthma. 2012;49(4):372–379. doi: 10.3109/02770903.2012.660296. - DOI - PubMed

Associated data