Academic journal article Central European Journal of Public Health

Validity of Asthma Control Test in Assessing Asthma Control in Czech Outpatient Setting

Academic journal article Central European Journal of Public Health

Validity of Asthma Control Test in Assessing Asthma Control in Czech Outpatient Setting

Article excerpt

INTRODUCTION

Asthma continues to be a major public health concern worldwide (1). In 2004, Masoli et al. (2) and the Global Initiative for Asthma (GINA) estimated the prevalence of current asthma symptoms in the Czech Republic to be 8% among adults (4). According to the World Health Survey (1) the prevalence rates of doctor diagnosed asthma, clinical/treated asthma and wheezing among adults in the Czech Republic were 4.5%, 4.7% and 6.3%, respectively. Achieving asthma control remains an elusive goal for the majority of patients worldwide (3). Asthma control is a key component for asthma treatment and asthma management (4, 5). Current clinical guidelines (4-6) emphasise the importance of asthma control evaluation rather than asthma severity in order to guide asthma management decisions. Therefore, more recently, the multidimensional concept of asthma control has been introduced to better describe the status of disease after intervention (7, 8). Asthma control "is generally considered to reflect disease activity as captured by punctuations in symptoms and the degree to which these symptoms limit activities, disturb sleep or require the use of a rescue inhaler" (9). Controlled asthma is characterised by minimal or no symptoms during the day and at night, no asthma attacks, no emergency visits to physicians or hospitals, minimal need for relieve medications, no limitation on physical activities and exercises, nearly normal lung function, and minimal or no side-effects from medication (10). The Global Initiative for Asthma (4) defines asthma control as "no limitations of activities, no nocturnal symptoms, minimal or no daytime symptoms, minimal or no need for rescue therapy, normal lung function, and no exacerbations". Despite the ongoing development of improved treatments for asthma and the availability of regularly updated, evidence-based guidelines, large population-based studies (e.g. the International Asthma Patient Insight Research - INSPIRE study, the Asthma Insights and Reality in Central and Eastern Europe - AIRE study, the Reality of Asthma Control - TRAC study, etc.) report that a substantial portion of adults with asthma is not optimally controlled (10-13).

Several patient-centred methods have been developed to measure asthma control, such as the Asthma Control Questionnaire (ACQ), Asthma Control Test (ACT), Asthma Control Scoring System (ACSS), or Asthma Therapy Assessment Questionnaire (ATAQ) (14-17). An international panel of experts invited by the International Primary Care Respiratory Group (10) recommended ACT and ACQ as validated and reliable tools responsive to changes in asthma control over time. ACT provides a more simplified assessment of control by not requiring lung function assessments (7, 15, 18, 19) and by providing a meaningful and easy scoring method that is simpler than previous asthma ques- tionnaires and comprehensive enough to evaluate the range of asthma control (7). Moreover, it can be applied at all levels of healthcare (7, 15, 18, 19).

In the Czech Republic, the GINA guidelines are used as the main reference source for the national asthma guidelines. However, studies evaluating the level of asthma control in the Czech Republic are still rare. A simple, applicable, accessible and validated tool to assess asthma control is therefore needed for patients with asthma in the Czech Republic. ACT has been the recent and most commonly used complementary tool in assessing asthma control in the Czech Republic. However, this tool has not yet been validated as a reliable predictor of GINA-defined asthma control here. A study was therefore undertaken to validate the Czech version of ACT.

The objective was to determine the reliability and validity of the agreement between ACT and GINA in classifying asthma control and to identify major determinants of pure asthma control.

Sample

This was an observational study recruiting ambulatory patients with asthma at the Clinic of Respiratory Diseases and Tuberculosis of the University Hospital in Ostrava, Czech Republic between November 2011 and July 2012. …

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