Relationship between asthma control status, the Asthma Control Test™ and urgent health-care utilization in Asia

• Published in: Respirology (Carlton, Vic.) Vol. 16; no. 4; pp. 688 - 697
• Main Authors: LAI, CHRISTOPHER K.W., KO, FANNY W.S., BHOME, ARVIND, DE GUIA, TERESITA S., WONG, GARY W.K., ZAINUDIN, BIN M.Z., NANG, AN N., BOONSAWAT, WATCHARA, CHO, SANG H., GUNASEKERA, KIRTHI D., HONG, JIAN G., HSU, JENG-YUAN, VIET, NHUNG N., YUNUS, FAISAL, MUKHOPADHYAY, AMARTYA
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.05.2011
• Subjects: Adolescent; Adult; Ambulatory Care - utilization; Asia; Asthma - diagnosis; Asthma - drug therapy; asthma control; Asthma Control Test; Child; Child, Preschool; community survey; Cross-Sectional Studies; Delivery of Health Care - utilization; exacerbation; Female; Global Initiative for Asthma; Health Care Surveys; Hospitalization; Humans; Male; Monitoring, Physiologic - methods; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome; urgent health-care utilization; Asia
• ISSN: 1323-7799; 1440-1843
• DOI: 10.1111/j.1440-1843.2011.01954.x

ABSTRACT Background and objective:  Accurate assessment of control is an integral part of asthma management. We investigated the relationship between control status derived from the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT) and urgent health‐care utilization. Methods:  Asthma Insights and Reality in Asia‐Pacific Phase 2 (AIRIAP 2) was a cross‐sectional, community‐based survey of 4805 subjects with asthma from urban centres across Asia. A symptom control index was derived from the AIRIAP 2 questionnaire using the GINA control criteria for day‐ and night‐time symptoms, need for rescue medication, activity limitation and exacerbations; lung function was excluded. The main outcomes were asthma control, based on these GINA criteria and the ACT, and the relationship between control and self‐reported urgent health‐care utilization (hospitalization, emergency room visits or other unscheduled urgent visits) related to asthma over the previous 12 months. Results:  Each of the symptom criteria was significantly associated with urgent health‐care utilization, with odds ratios (ORs) ranging from 2.25 (95% confidence interval (CI): 1.94–2.61) for daytime symptoms to 2.57 (95% CI: 2.29–2.90) for nocturnal awakening. Similarly, control status was significantly associated with urgent health‐care utilization, with ORs of 0.19 (95% CI: 0.13–0.28), 0.70 (95% CI: 0.65–0.76) and 1.00 for controlled, partly controlled and uncontrolled, respectively. The optimal ACT cut‐off score for identifying uncontrolled asthma was ≤19 for subjects aged ≥12 years. Urgent health‐care utilization was reported by 57.2% versus 28.7% of patients scoring ≤19 versus >19 (P < 0.001). Conclusions:  The GINA control classification and the ACT are valid symptom‐based measures that are significantly associated with urgent health‐care utilization. A GINA‐derived symptom control classification and the ACT are significantly associated with urgent health‐care demand in a sample of 4805 community‐based asthmatic subjects across Asia. Symptom‐based measures may facilitate assessment of control.