Asthma Control Test Questionnaire Research Articles

Double-blind randomised placebo-controlled trial of bolus-dose vitamin D3 supplementation in adults with asthma (ViDiAs)

RationaleAsthma exacerbations are commonly precipitated by viral upper respiratory infections (URIs). Vitamin D insufficiency associates with susceptibility to URI in patients with asthma. Trials of vitamin D in adults with...

Study the pattern of bronchial asthma among outpatients clinic at Sohag and Akhmeem Chest Hospitals

BackgroundWhile asthma represents a global public health issue due to high prevalence rates in the general population, several studies now indicate that the impact on public health is even more severe due to inadequate health care or the difficulty in achieving full disease control with available therapies. Aim of the workThe aim of the present study is to evaluate the pattern, risk factors, level of control and management of bronchial asthma among outpatients clinic at Sohag and Akhmeem Chest Hospitals. Subjects and methodsThis study was conducted at Sohag and Akhmeem Chest Hospitals in the period between January 2011 and June 2011 and included 100 adult outpatients with bronchial asthma (BA) with a wide range of severity. Full history taking, thorough clinical examination, CXR, Peak expiratory flow (PEF), Asthma control test (ACT) questionnaire for all patients were done. ResultsBy using ACT, from one hundred cases of our study: 18% of cases have controlled asthma, 39% of cases have not well controlled asthma, 43% of cases have poorly controlled asthma. Tobacco smoke and infections were the most common precipitating factors to bronchial asthma. Inhalation therapy was used by 70% of the patients and MDI is the most commonly used inhalation device. ConclusionsThere is need for improved asthma care in patients with moderate-to-severe asthma, including a global evaluation of asthma control, implementation of treatment plans and asthma control tests and addressing precipitating factors.

YKL-40 is correlated with FEV1 and the asthma control test (ACT) in asthmatic patients: influence of treatment.

BackgroundYKL-40 is also called chitinase-3-like-1 (CHI3L1) protein and may be a marker for asthma. The aims of the present study were to investigate whether serum YKL-40 levels are stable or decreased in patients with asthma after appropriate treatment and to evaluate the correlation of YKL-40 levels with lung function and asthma control test (ACT) results.MethodsA total of 103 asthmatic patients (mean age 33.1 ± 0.9 years) with diagnosed asthma were enrolled in our study. All patients underwent a detailed clinical examination and completed the ACT questionnaire, serum YKL-40 measurement, and spirometry before (visit 1) and 8 weeks after initiation of treatment (visit 2).ResultsAt the follow-up, the median serum YKL-40 level was significantly decreased compared to the levels at visit 1 (75.2 [55.8-86.8] ng/ml versus 54.5 [46.4-58.4] ng/ml, p < 0.001). The serum YKL-40 level was negatively correlated with %FEV1 (r = -0.37, p < 0.001) and ACT score (r = -0.26, p = 0.007) at visit 1. The change in serum YKL-40 levels between the visits was significantly correlated with changes in FEV1 (r = -0.28, p = 0.006) and ACT score (r = -0.22, p = 0.037). Patients with elevated YKL-40 levels had significantly greater corticosteroid use than patients with lower levels.ConclusionsYKL-40 was reduced in the serum of asthmatic patients after appropriate treatment, and the levels correlated with improvements in %FEV1 and ACT. High levels of serum YKL-40 may be refractory to current asthma treatments.Trial registrationChiCTR-OCC-13003316Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2466-15-1) contains supplementary material, which is available to authorized users.

Symptom control in asthma, relationship with life quality and the effect of patient training on the control of symptoms

Methods Data were gathered through the questionnaire. Asthma Control Test(ACT) and SF-36 life quality questionnaire (SF-36 LQQ) were applied to the patients. Respiratory functions were measured. Treatments of the patients were given according to GINA guideline. Trainings of patients were offered. Approximately one month later; ACT and SF-36LQQ were repeated. Data were analyzed through SPSS10.0, and the relationship between ACT and SF-36LQQ was investigated by correlation analysis.

Real-world effect of gastroesophageal reflux disease on cough-related quality of life and disease status in asthma and COPD

BackgroundGastroesophageal reflux disease (GERD) is one of the most common causes of chronic cough and often coexists with asthma or chronic obstructive pulmonary disease (COPD); however, it is unknown whether there are differences in the effect of GERD on these diseases. The purpose of this study was to assess the difference in the effect of GERD on cough-related quality of life and disease status in asthma and COPD in a real-world setting. MethodsSubjects were 132 patients with overall controlled asthma and 102 patients with stable COPD. They completed the frequency scale for symptoms of GERD (FSSG), a validated Japanese questionnaire for GERD, the Leicester Cough Questionnaire (LCQ), and the Asthma Control Test (ACT) or COPD assessment test (CAT) questionnaires. ResultsWe found that 29 (22.0%) patients with asthma and 22 (21.6%) patients with COPD had GERD. There was no difference in the FSSG scale between the diseases. The patients with GERD, regardless of having asthma or COPD, had lower LCQ scores affecting all health domains and lower ACT or higher CAT scores than those without GERD. Overall, the patients with COPD had lower LCQ scores regardless of the presence or absence of GERD. The FSSG scale was negatively correlated with the LCQ total score in asthma and in COPD. In contrast, the FSSG scale was positively correlated with the CAT score but not with the ACT score. ConclusionsPatients with GERD had impaired cough-related quality of life, poor asthma control or more symptoms and impacts of COPD.

Validation of the Asthma Control Test in pregnant asthmatic women

To determine the validity of the Asthma Control Test (ACT) questionnaire for assessing pregnant asthmatic women. The study involved 40 pregnant asthmatic women over a total of 113 medical visits. On each occasion the participants had a pulmonary function test and a clinical evaluation to assess the level of asthma control. In addition, the ACT was carried out with the obstetrician being blinded to its results. The most accurate cut-off point was 16, with a sensitivity of 95.4%, specificity of 68.8%, a negative predictive value of 91.7% and a positive predictive value of 80.5%. The positive and negative likelihood ratios were 3.052 and 0.067 respectively. The questionnaire was found to be highly effective for discriminating between controlled and uncontrolled asthma, with an area under the receiver operating characteristic (ROC) curve of 0.846 (95%CI: 0.748-0.92). Reliability assessed in patients with the same clinical classification resulted in an intra-class correlation coefficient of 0.86 (95%CI: 0.75-0.93). Improved clinical conditions corresponded to a significant increase in the ACT score (p < 0.005), indicating good responsiveness to changes in clinical status. The ACT proved to be reliable and could discriminate between levels of asthma control in pregnant women confirming its value as a useful tool for the management of asthma during pregnancy.

Overweight and obesity as risk factors for impaired lung function in patients with asthma: A real-life experience.

Several studies have outlined a possible relationship between an increased body mass index (BMI) and asthma. The aim of the study was to investigate in patients with asthma, enrolled in a real-life setting, a possible relationship between BMI and asthma parameters, including lung function markers (i.e., forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], FEV1/FVC ratio, and forced expiratory flow at 25-75%), fractional concentration of exhaled nitric oxide (FeNO), asthma control level, Asthma Control Test (ACT), comorbid allergy, and allergic rhinitis (AR). The study included 286 patients with asthma. All subjects were evaluated performing clinical examination, spirometry, FeNO measurement, and ACT questionnaire. Ninety-six (33.6%) patients were overweight and 45 (14.1%) patients were obese. Lung function was significantly impaired in overweight and obese asthmatic patients in comparison with normal-weight ones. Increased BMI did not affect FeNO values and asthma control level. Overweight patients had double the risk (odds ratio [OR], 1.89) and obese patients had triple the risk (OR, 3.17) of having pathological FEV1 in comparison with normal-weight patients. Both in overweight (OR, 2.415) and obese patients (OR, 2.126), the risk to have pathological FEV1/FVC was about two times higher than in normal-weight patients. In overweight and obese asthmatic patients the probability of allergy was, respectively, 3.5 times (OR, 0.285) and 4.5 times (OR, 0.224) lower compared with normal-weight asthmatic patients. The risk of suffering from AR was three times lower in overweight (OR, 0.331) patients and six times lower in obese (OR, 0.163) patients. The present study suggests that BMI assessment should be routinely considered in asthmatic patients to reveal bronchial obstruction, also, in controlled asthma.

Vitamin D deficiency and level of asthma control in women from North of Jordan: a case–control study

Introduction: Reduced vitamin-D levels in patients with asthma have been associated with impaired lung function, increased airway hyper-responsiveness, and reduced glucocorticoid responsiveness. Nationwide studies revealed a considerable prevalence of vitamin-D deficiency (VDD) in Jordanian women. Objective: A case–control study was conducted to determine the relationship between serum vitamin A and D levels and asthma among women in North of Jordan. Methods: Sixty-eight asthmatics, age range between 14 and 65 years and 77 healthy women, age range between 19 and 51 years, were enrolled. Asthma severity was classified using Global Initiative for Asthma (GINA) guidelines and Asthma Control Test (ACT) questionnaire. Serum vitamin-A and 25-hydroxyvitamin-D (25(OH)D3) levels were measured using high-performance liquid chromatography (HPLC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods, respectively. Results: The prevalence of VDD (<15 ng/ml) was higher but not statistically significant for women with asthma compared with controls (95.6% vs. 87.0%; p = 0.070). The severity of VDD correlated with the number of asthma medications (p = 0.020). 25(OH)-D3 serum levels directly correlated with asthma control level using ACT score (p = 0.012) and GINA classification (p = 0.046). After adjusting for age, the odds of having VDD for asthmatic women were 35.9 times higher than that for women with no asthma. There was no difference in serum vitamin-A level between healthy and asthmatic women (p = 0.214) and none had vitamin-A deficiency (<200 µg/dl). Conclusions: VDD is prevalent in women with asthma in northern Jordan. The severity of VDD correlated with poor asthma control and a need for more medications to control asthma. There was no association between vitamin-A and asthma.

Validation of Rules of Two™ as a Paradigm for Assessing Asthma Control

Assessing asthma control at each patient encounter is an essential task to determine pharmacologic requirements. Rules of Two (Ro2) was created from the original 1991 National Asthma Education Program guidelines to determine the need for controller therapy. This study determined the degree of agreement between Ro2 and the Expert Panel Report (EPR-3) definition of “in control” asthma and compared that value with the Asthma Control Test (ACT) in a group of asthmatics for the purpose of validating this tool. Patients with documented asthma were randomized to complete Ro2 or ACT prior to being assessed for asthma control by certified asthma educators using an EPR-3 template. Assessments occurred in either a specialty asthma clinic or at a local health fair. Patients were also queried for their personal assessment of asthma control. The primary statistical methodology employed was the degree of agreement (kappa) between each survey tool and the EPR-3 template. Of 150 patients, 72% did not have their asthma in control, based on the EPR-3 template. Ro2 identified 58% of patients not in control of their asthma, whereas ACT identified 36%, with kappa scores of 0.41 for Ro2 and 0.37 for ACT compared with the EPR-3 template. These were not significantly different. Of the 150 patients, 75% considered their asthma in control based on self-assessments, with a kappa of 0.23. In 14 of 73 ACT questionnaires, scores were not added or were misadded. Eliminating evaluation of static lung function significantly improved both kappa scores of Ro2 and ACT. In conclusion, Ro2 identifies patients with uncontrolled asthma as well as ACT and may be useful to the primary assessing clinician in determining asthma control.

Switching from systemic steroids to ciclesonide restores the hypothalamic pituitary-adrenal axis.

IntroductionTreatment of difficult asthma with oral corticosteroids (OCS) may suppress the hypothalamic-pituitary-adrenal axis.AimIn this study we have checked if the substitution of OCS with very high doses of ciclesonide may restore the adrenal function without losing the control of the disease.Material and methodsIn 5 patients with difficult, uncontrolled asthma despite treatment with OCS, inhaled and systemic glucocorticosteroids were replaced with very high doses of ciclesonide (1600–2400 µg/day). The symptoms of asthma and the lung function were assessed at baseline and on the 28th, 56th and 70th day of treatment, whereas the levels of cortisol and adrenocorticotropic hormone (ACTH) in the morning were measured at baseline and on the 28th and the 56th day of treatment.ResultsIn all patients, the control of asthma symptoms, measured with Asthma Control Test questionnaire, improved from the mean score of 9.4 to 19.8 in 70 days. In 4 subjects force expiratory volume in 1 s improved gradually through the entire study reaching a mean improvement of 585 ml in 70 days. The ACTH levels were normalized in 3 patients after 28 days of observation and in all patients after 56 days. The cortisol level was normalized in 4 patients after 28 days and in another subject after 56 days of treatment with ciclesonide.ConclusionsSwitching from prednisone to very high doses of ciclesonide normalized the hypothalamic-pituitary adrenal axis function and also improved the disease control and the lung function in these 5 patients with difficult asthma.

Validity, reliability and discriminative capacity of an electronic quality of life instrument (Pelican) for childhood asthma in the Netherlands

To assess psychometric properties of the Pelican instrument, an online Dutch self-administered Quality of Life instrument for childhood asthma for scientific and clinical use. A cohort study was done in two asthma populations and healthy children. One asthma population had assessment at start, 4 and 8weeks. The other asthma population and healthy children had one assessment. All children were aged 6-12years. Children completed the Pelican instrument, Paediatric Asthma Quality of Life Questionnaire, feeling thermometer and Childhood Asthma Control Test. Lung function and fraction exhaled nitric oxide were measured. Parents completed Functional Status II, Asthma Control Questionnaire, Childhood Asthma Control Test questionnaires and symptom diaries. We assessed interpretability, structural validity, internal consistency, reliability, construct and discriminative validity of the Pelican instrument. Eighty-five asthmatic (mean age 8.5years) and 49 healthy children (mean age 8.4years) participated. The Pelican instrument has 5 domains with 21 items after factor analysis. Internal consistency was 0.89 (CI 0.85-0.92), domain reliability showed Cronbach's α's from 0.64 to 0.76 and item-to-scale correlations from 0.61 to 0.81. Test-retest reliability was confirmed ICC=0.88 (CI 0.79-0.93). Construct validity was demonstrated by significant moderate correlations with other relevant asthma outcomes like PAQLQ (r=-0.59, p<0.01). Discriminative capacity between controlled or uncontrolled asthma (t=3.20, p<0.01, Δ=0.64) and asthma versus healthy subjects (t=6.31, p<0.01, Δ=0.94) was found. The psychometric properties of the Pelican instrument were acceptable in Dutch paediatric asthma patients between 6 and 12years old.

Impacto de la administración del cuestionario Asthma Control Test en atención primaria sobre la puntuación de control del asma

ObjectiveTo compare the score indicative of asthma control obtained using the Asthma Control Test (ACT®) questionnaire administered by primary health care physicians, habitual users of the questionnaire, and those were not. DesignA multicentre, prospective, epidemiological study. SettingPrimary health care centres in Spain. ParticipantsTwo study populations were defined: «ACT® users» and «non-ACT® users», according to the use of the ACT® questionnaire by their respective primary health care physicians. Main measurementsThe patients completed the ACT® questionnaire during a baseline visit, and in another follow-up visit at 8 weeks. The primary outcome was the percentage of patients with an ACT® score ≥ 20. The change in the ACT® score was analysed if there was a change in treatment. ResultsThere was a higher percentage of patients with well-controlled asthma in the ACT® users group after 8 weeks (68.5% vs. 55.6%; P=.01). A significant increase in the ACT® score was observed in the follow-up visit compared to the baseline visit, when there was a change in treatment in both groups (2.5 and 3.8 points, ACT® users and non-ACT®-users, respectively, P=.001 and P<.0001). ConclusionsThe administering of the ACT® questionnaire improved the score indicative of asthma control in both populations of the study, with a higher score being obtained in those patients attended by physicians with previous experience in the use of ACT®. The administering of the ACT® questionnaire could contribute to improving the long-term outcome of the patient, and favouring the appropriateness of the treatment.

Comparison of Asthma Control Test (ACT) and Global Initiative for Asthma (GINA) in the Assessment of Asthma Control and Usefulness of Act in a Resource Poor Setting

Background: The gold standard in assessing asthma control is the Global Initiative for Asthma (GINA) criteria. It is difficult to follow GINA criteria in assessing asthma control in resource poor settings because of the lack of access to pulmonary functions tests. The Asthma Control Test (ACT) questionnaire is a simple, self-administered, accessible and validated tool that is used in assessing control among asthmatics. The ACT has the added advantage that it does not require lung function assessment. However, its relationship with GINA guideline-defined asthma control has not been clarified in our setting. Aim: The aim of this study is to assess asthma control through ACT and GINA, and to determine if the ACT can be as useful as the GINA-guidelines criteria in assessing asthma control in our setting. Methodology: It was a cross-sectional analytical study. Asthma control was assessed by the ACT and GINA criteria questionnaires. Pulmonary function tests were performed on the subjects according to American Thoracic Society (ATS) guidelines. The sensitivity, specificity, negative and positive predictive values of ACT were determined. Results: A total of 65 asthmatics participated in this study. The level of asthma control among the subjects was poor, 37% and 23% by ACT and GINA criteria respectively. There was a significant and positive correlation between the ACT and GINA. The Kappa score for the entire subjects was 0.66 representing a substantial agreement between the ACT and GINA. Conclusion: Asthma control was poor among the subjects. The fact that ACT can predict GINA guidelines-based level of control further gives credence to its usefulness in a resource-poor clinical setting.

The knowledge, attitudes and practices of parents of children with asthma in 29 cities of China: a multi-center study.

BackgroundAsthma is becoming increasingly prevalent among children in China. Poor parent knowledge and attitudes often contribute to inappropriate management practices, leading to deficiencies in the care process. We aimed to document the knowledge, attitudes and practices (KAP) of parents of children with asthma and analyze how knowledge and attitudes relate to practices. Our secondary objective was to identify the factors associated with parent KAP scores.MethodsA KAP questionnaire was distributed to parents caring for 2960 children (0–14 years) diagnosed with asthma for at least 3 months from China’s 29 provinces. A 50-item questionnaire was devised for this cross-sectional survey based on a comprehensive review of the subject. Questionnaires were scored on 30 items regarding parent asthma-related KAP, with one point for every correct response and a possible range of 0–13 for knowledge, 0–7 for attitudes and 0–10 for practices. Higher scores indicated better KAP. Chi-squared tests and logistic regression were used to identify factors associated with practices and combined KAP scores.ResultsThe response rate was 83.95% (2485/2960). Only 18.31% (455/2485) of parents correctly answered ≥ 60% of the knowledge questions (mean = 5.69). Most (89.85%; 2226/2485) gave positive responses to ≥ 60% of the attitude questions (mean = 5.23) while 67.89% (1687/2485) correctly answered ≥ 60% of the practices questions (mean = 6.19). Knowledge and attitudes were positively associated with pulmonary function testing, regular physician visits, monitoring with a peak flow meter and the Children’s Asthma Control Test questionnaire, avoidance of asthma triggers, using an inhaled β2 receptor agonist and adherence to medication regimen (p ≤ 0.05). Attitudes were also associated with allergen testing. In logistic regression analysis, high KAP scores (dichotomized by a cut-off score of 18) were positively associated with food allergy, rhinitis, physician visits, frequency of visits and parent education (p < 0.05, OR > 1).ConclusionsGenerally, the parents’ KAP were poor. A gap between recommended and actual practice was observed, which may be related to inadequate knowledge about and poor attitudes toward childhood asthma. Improving knowledge and attitudes may encourage better practices among parents of children with asthma.

Bronchial Asthma Correlates with Vitamin D Status of Adult Women in North Jordan

We wanted to study the association between Vitamins D and A levels and Asthma in adult females in northern Jordan where there is limited sun exposure because of social clothing customs. 68 asthmatics and 77 control age related females were enrolled. Patients with asthma exacerbation within 1 month of the study, diseases that might affect vitamin D or history of smoking were excluded. Control group consists of individuals with no history of asthma, were screened for asthma symptoms using asthma Life Quality test questionnaire and had normal flow spirometry. Asthma severity was classified according to GINA guidelines using Asthma Control Test (ACT) questionnaire. Vitamins D and A serum levels were measured using LC/MS and HPLC methods respectively. Statistical analysis was performed using Independent Sample t-tests. Statistically significant difference (p value of 0.027) was found between the mean level of vitamin D in Asthmatics (8.3 ± 3.22 μg/dL) and controls (10.5 ± 7.63 μg/dL). Vitamin A levels were not significantly different between Asthmatics (441.1 ± 121.7 μg/dL) and controls (418.6 ± 95.6 μg/dL). Asthma patients were found to have a more severe form of vitamin D deficiency and deficiency level correlated with the severity of asthma control. This can be explained by a possible causative effect of vitamin D deficiency on Asthma phenotype or as a result of limitation of out-door activities and sun exposure caused by asthma. Further study for a possible therapeutic effect of vitamin D supplement on Asthma control and severity might be needed.

The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analysis

Currently, the cornerstone of asthma management is the achievement and maintenance of optimal asthma control, but the diagnostic performances of the Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) have not been evaluated systematically. We explored the diagnostic performances of and statistically compared the ACT and ACQ. Studies that examined the accuracy of the ACT, ACQ, or both in the assessment of asthma control were found by searching PubMed, CENTRAL, Web of Science, Ovid, and Embase. Summary estimates of sensitivity, specificity, and diagnostic odds ratios for the different levels of asthma control were determined by using bivariate random-effects models and hierarchical summary receiver operating characteristic models. Twenty-one studies with 11,141 subjects assessed with the ACT and 12,483 assessed with the ACQ were identified. The ACT had good diagnostic accuracy for assessment of controlled and not well-controlled asthma, and the ACQ (ACQ-7 and ACQ-6) had good diagnostic accuracy for assessment of not well-controlled asthma at prespecified cutoff points. The ACT and ACQ had significant differences in the assessment of controlled and not well-controlled asthma after adjusting for potential factors (P = .001 and P = .015). For assessment of uncontrolled asthma, the ACT had poor accuracy, with a hierarchical summary receiver operating characteristic area under the curve of 0.69, and the cutoff point for the ACQ has not been established. The ACT is preferable to the ACQ in clinical practice, and the ACQ requires further cross-validation. Moreover, neither the ACT nor the ACQ is useful for the assessment of uncontrolled asthma.

Association of gastroesophageal reflux disease with asthma control

Gastroesophageal reflux disease (GERD) may make asthma difficult to control and may be a potential risk factor for frequent asthma exacerbations, but the mechanisms of the relationship between GERD and not well-controlled asthma remain unclear. The aim of this study was to explore the association of GERD with asthma control in adults. Patients with asthma were consecutively recruited, and Asthma Control Test (ACT) and Reflux Diagnostic Questionnaire scores were determined. The patients were categorized into not well-controlled asthma and well-controlled asthma groups according to the ACT score. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between GERD and not well-controlled asthma. Seven hundred and sixty-eight patients with asthma were enrolled. The mean ACT score was 18.2 ± 3.6, and there were 161 (21.0%) patients with not well-controlled asthma. The Reflux Diagnostic Questionnaire score was 10.5 ± 4.7, and 212 (27.6%) patients were complicated by GERD. Multivariate logistic regression analyses revealed the independent association of GERD with not well-controlled asthma (odds ratio, 3.12; 95% confidence interval, 1.53-4.88) after other established contributors to asthma control were adjusted. In conclusion, there is an association of GERD with not well-controlled asthma, independent of other potential contributors to asthma control.

Expression and significance of programmed cell death 5 in patients of branchial asthma

To explore the expression and significance of serum programmed cell death 5 (PDCD5) in patients with bronchial asthma. From June to December 2011, a total of 40 adults with bronchial asthma treated in Peking University Third Hospital were enrolled. Among them, the categories were acute phase (n = 12), chronic phase (n = 14) and remission phase (n = 14). Fifteen healthy adults were selected into the control group. The percentages of peripheral blood neutrophils and eosinophils were collected and detected for each patient. Serum PDCD5 was detected with enzyme-linked immunosorbent assay (ELISA) and asthma control test (ACT) questionnaire filled in. The relevant pulmonary functional indicators were analyzed with a pulmonary spirometer. Two-independent sample t-test and Pearson's correlation analysis were used for statistical analysis. No significant difference was found between two groups with regards to the percentages of peripheral blood eosinophils and neutrophils (all P > 0.05). Serum PDCD5 was significantly higher in the patient group ((47.7 ± 29.6) vs (19.3 ± 9.8) µg/L, P < 0.05). Patients of chronic and acute phases showed a significant higher expression in PDCD5 than the remission phase ((55.2 ± 24.5) & (68.5 ± 22.1) vs (16.0 ± 7.9) µg/L, both P < 0.05). Serum PDCD5 of asthmatics showed a negative correlation with FEV(1)%, FEV(1)/FVC ratio and ACT scores (r = -0.539 to -0.798, all P < 0.05). PDCD5 participates in the inflammatory process of asthmatic airway. Its abnormal expression may be associated with the uncontrolled state of asthmatics. It may serve as an indicator of assessing the levels of asthma control or a target for the treatment of asthma.

Asthma Control Test (ACT): Comparison with Clinical, Functional, and Biological Markers of Asthma Control

Background. Asthma Control Test (ACT) is a simple tool for assessing the level of asthma control in clinical practice, and it has been validated in comparison with a general clinical assessment of asthma control, including forced expiratory volume in the first second (FEV1). Objective. To evaluate the relationship between ACT score and clinical and functional findings of asthma control and biomarkers of airway inflammation. Methods. A total of 68 asthmatic patients observed in our asthma clinic (33 regularly treated with inhaled corticosteroids (ICS) and 35 ICS-naïve) filled ACT questionnaire and underwent the following measurements: (a) FEV1 before and after salbutamol; (b) exhaled nitric oxide; (c) bronchial hyperresponsiveness to methacholine; (d) sputum eosinophil count; and (e) daytime and nighttime symptoms, rescue salbutamol, and twice-daily peak expiratory flow (PEF) recording on a 4-week diary card. Results. ACT score significantly correlated with symptom score, rescue medication use, and PEF variability, but not with FEV1, FEV1 reversibility, and markers of airway inflammation, which could not distinguish controlled from uncontrolled patients according to ACT, regardless of ICS treatment. Conclusion. ACT score is a valid tool to simply assess the current level of asthma control in terms of symptoms, rescue medication use, and PEF variability. Pulmonary function and biomarkers of airway inflammation are not related to the clinical asthma control as assessed by ACT and may represent additional measurements potentially useful in asthma management.

449 Usefulness of Asthma Control Test Questionnaire, FEV1 and Exhaled Nitric Oxide Level (FENO) for the Clinical Assessment of Elderly Asthma

BackgroundAsthma remains a prevalent disease with significant morbidity and mortality, therefore numerous markers or measurements for the evaluation of its severity are available. Functional parameters, clinical assessment and biomarkers of inflammation are the most used. Also the diagnosis and treatment of asthma are often focused on young patients. This study was intended to determine the usefulness of patient-based questionnaire, Asthma Control Test score (ACT), forced expiratory volume in 1 second (FEV1) and exhaled nitric oxide (FeNO) for clinical assessment of elderly asthma patients.Patients and MethodsSixty seven (67) patients with a diagnosis of asthma more than 65 of age were enrolled. They performed spirometry, FeNO measurement and answered the ACT questionnaire. ACT is scored on a scale from 5 to 25 with higher values reflecting better control. Spirometry measures that met the American Thoracic Society criteria were included. FeNO was measured with values ≥35 ppb indicating probability of airway inflammation. Qui-square test was used for statistical analysis.Results67 patients (15% female), mean age of 72.3 (65–89) were included. 25 patients (37.3%) were very poorly controlled, ACT ≤ 15 and mean values of FEV1 81.5+21.5 (% predicted) and mean FeNO of 41 ± 35 ppb. Thirty patients (44.8%) were not-well-controlled, ACT 16 to 19, FEV1 89% ± 16.8, FeNO of 40 ± 36 and 12 patients (17.9%) were well-controlled, ACT ≥ 20, FEV1 93.3 ± 16.8 and FeNO of 44 ± 35. FEV1 as >80% of predicted in 62.4% of patients (ACT 7–25) and 75% of patients with ACT ≥ 20 had FEV1 > 80%. The relation between ACT and FEV1 in this study was statistically significant (P = 0.014). There was no correlation when we evaluated ACT/FeNO and FEV1/FeNo variables (P = 0.45, 0.41 respectively).ConclusionsA good correlation was found between ACT and FEV1, with higher ACT scores reflecting less bronchial obstruction. FeNO values had no correlation with ACT or FEV1, indicating that this marker of inflammation had less interest for assessment of asthma control in these elderly patients. In spite of these data, we still advise that the clinical assessment of asthma should be based on a combined approach that involves clinical aspects, functional parameters and biomarkers of inflammation, because elderly patients may have reduced symptom perception and have multiple co-morbidity.