The Journal of Allergy and Clinical Immunology
Volume 119, Issue 4 , Pages 817-825, April 2007

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

  • Andrew H. Liu, MD

      Affiliations

    • From National Jewish Medical and Research Center and the University of Colorado School of Medicine, Denver
    • Corresponding Author InformationReprint requests: Andrew H. Liu, MD, National Jewish Medical and Research Center, 1400 Jackson Street (K1023), Denver, CO 80206.
    • ,
  • Robert Zeiger, MD

      Affiliations

    • Kaiser Permanente, San Diego
    • ,
  • Christine Sorkness, PharmD

      Affiliations

    • University of Wisconsin School of Pharmacy, Madison
    • ,
  • Todd Mahr, MD

      Affiliations

    • Gundersen Lutheran Clinic, LaCrosse
    • ,
  • Nancy Ostrom, MD

      Affiliations

    • Allergy and Asthma Medical Group and Research Center, San Diego
    • ,
  • Somali Burgess, PhD

      Affiliations

    • Mapi Values, Boston
    • ,
  • Jacqueline Carranza Rosenzweig, PharmD, MS

      Affiliations

    • GlaxoSmithKline, Research Triangle Park
    • ,
  • Ranjani Manjunath, MSPH

      Affiliations

    • GlaxoSmithKline, Research Triangle Park

Received 8 September 2006; received in revised form 20 November 2006; accepted 13 December 2006. published online 15 March 2007.

Denver, Colo, San Diego, Calif, Madison and LaCrosse, Wis, Boston, Mass, and Research Triangle Park, NC

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.

Key words: Asthma, pediatric, control, health outcomes, health-related quality of life, symptom assessment, questionnaire, tool

Abbreviations used: AUC, Area under the curve, C-ACT, Childhood Asthma Control Test, FVC, Forced vital capacity, GINA, Global Initiative for Asthma, NAEPP, National Asthma Education and Prevention Program, NPV, Negative predictive value, PAQLQ, Pediatric Asthma Quality of Life Questionnaire, PACQLQ, Pediatric Asthma Caregiver's Quality of Life Questionnaire, PPV, Positive predictive value, ROC, Receiver operating characteristic

 

 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.

PII: S0091-6749(07)00167-4

doi:10.1016/j.jaci.2006.12.662

The Journal of Allergy and Clinical Immunology
Volume 119, Issue 4 , Pages 817-825, April 2007

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