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Validation of the Arabic version of the asthma control test  [cached]
Lababidi H,Hijaoui A,Zarzour M
Annals of Thoracic Medicine , 2008,
Abstract: Purpose: Asthma control test (ACT) has been devised to assess the degree of asthma control in out-patients setting. The aim of this study is to validate the Arabic version of ACT. Materials and Methods: Patients completed the Arabic version of ACT during regular visit to one of two asthma specialists. Spirometry was obtained. The asthma specialist rated asthma control using a 5-point scale and indicated modification in management as step up, same or step down of asthma treatment. Results: 40 patients completed the study, the mean age was 32.6 + 14.0 years, mean FEV1 was 2.7 + 1.0 L (89.2% + 23.6% of predicted). The mean ACT score was 15.9 + 5.8; mean of specialist asthma control rating was 3.4 + 1.0. The internal consistency reliability of the 5-item ACT survey was alpha = 0.92. The correlation was moderate between ACT and specialists rating ( r = 0.482, P = 0.002) and between ACT and treatment modification ( r = -0.350, P = 0.027). The correlation between FEV1 and ACT was low ( r = 0.185, P = 0.259). ACT distinguished between patients with different specialist rating ( F = 3.37, P = 0.02) and the need to change therapy ( F = 3.62, P = 0.037). The areas under the curve (ROC) for ACT, FEV1, and ACT and FEV1 as independent variables were 0.720, 0.721, and 0.766 respectively. All results were comparable to the initial work for development of ACT. Conclusion: The Arabic version of the ACT is a valid tool to assess asthma control. ACT correlates better with asthma specialist rating of asthma control than with FEV1.
Impact of asthma education meeting on asthma control level assessed by asthma control test
Ay?e Kavut, A Füsun Kalpakl?o?lu
World Allergy Organization Journal , 2010, DOI: 10.1097/wox.0b013e3181c82002
Abstract: An observational study in subjects who were diagnosed as suffering with persistent asthma was performed. All asthmatic patients who were followed up in healthcare centers around the city were invited to the study. Patients who consented were informed about the study and then skin prick tests, pulmonary function tests, and blood analyses were performed. In addition, a self-administered generic QoL questionnaire (SF-36) was completed. Finally, the patients were invited to attend the asthma awareness session, and pre-post educational ACT assessments were evaluated.Overall asthma control was less than optimal in almost half of the study group. ACT level changed in 70.5% of the patients. The change in asthma control by using ACT was prominent in the ACT-deteriorated group than the ACT-improved group (-3.8 ? 2.7 and 2.1 ? 1.3, respectively; P = 0.001). Regarding comorbidities, the ACT-deteriorated group had the highest prevalence of rhinitis (P = 0.04). The impairment in QoL was similar between the groups and the physical domains of SF-36 were correlated with the ACT scores. The correlation between education level and asthma control was found to be significant after the training session (r = 0.353, P = 0.04).Education in asthma is an essential strategy not only to achieve awareness of asthma control level as assessed by ACT, but also for the reliability of QoL measurement.
Does asthma control as assessed by the asthma control test reflect airway inflammation?
Mine Bora, Aylin Alpaydin, Arzu Yorgancioglu, Gizem Akkas, Ayd?n Isisag, Ays?n Coskun, P?nar Celik
Multidisciplinary Respiratory Medicine , 2011, DOI: 10.1186/2049-6958-6-5-291
Abstract: Stable asthmatic patients admitted to our pulmonary outpatient clinic were enrolled in the study consecutively and underwent the ACT, pulmonary function tests and methacholine bronchial provocation test (MBPT). Additionally, fractional exhaled nitric oxide level (FeNO) and induced sputum cell distribution were assessed. All these parameters were re-evaluated at the third month after adjusting medications of the patients according to baseline ACT scores.Of the 101 patients screened, we analyzed 83 who proceeded to the follow up visit. At the baseline visit, 8 were totally controlled, 36 partially controlled and 39 uncontrolled according to ACT. At the follow up visit, 10 were totally controlled, 39 partially controlled and 34 uncontrolled. Comparison of the two visits in terms of all parameters revealed significant reductions only in the percentages of patients with MBPT positivity (p = 0.029) and FeNO levels > 20 ppb (p = 0.025) at follow up. The percentages of patients with FeNO > 20 ppb, MBPT positivity, induced sputum eosinophilia or induced sputum neutrophilia did not show significant differences between totally controlled, partially controlled and uncontrolled groups at both baseline and follow up visits.Although the ACT scores did not show significant correlations with the airway inflammation parameters tested in this study, a marked reduction in the percentage of patients with MBPT positivity and FeNO > 20 ppb at follow up may suggest the importance of the control concept in the management of asthma.Asthma is a chronic disease characterized by inflammation of the airways [1]. It has been reported that the inflammatory process is strongly correlated to airway hypersensitivity and asthma symptoms. Monitoring the severity of the disease and treatment response by evaluating airway inflammation may enable a better control of the disease [2].Current guidelines for the diagnosis and treatment of asthma have particularly focused on managing asthma according to the co
Does the asthma control test reflect inflammation?
Margherita Neri
Multidisciplinary Respiratory Medicine , 2011, DOI: 10.1186/2049-6958-6-5-270
Abstract: The conclusion of the authors is that, although ACT scores did not show significant correlations with the airway inflammation parameters tested in the study, a marked reduction in the percentage of patients with MBPT positivity and FeNO > 20 ppb in the follow up may underscore the importance of focusing on the control concept in the management of asthma.Today asthma treatment is based not only on assessing asthma severity, but also on achieving and maintaining asthma control [2-4]. There is general agreement that a great proportion of people with asthma are not optimally controlled [5,6].Over a period of several years, numerous tools have been developed to determine the level of asthma control with the main aim of guiding treatment changes [7-9]. A step-up in treatment is recommended in order to achieve asthma control in uncontrolled patients and a step-down is suggested in well controlled patients [2]. ACT has been shown to be useful in the detection of poorly controlled asthma both in adults and children [9-11].ACT is a 5-item, self-completed questionnaire. The five items evaluate: limitation of daily activities, shortness of breath, night-time waking, use of reliever medication and the patient's perception of asthma control in the 4 weeks prior [9,10]. For each question there are five possible answers, scored from 1 to 5. The total ACT score is the sum of the scores attributed to the five questions, ranging from 5 (poorest asthma control) to 25 (optimal asthma control). ACT has been validated for adult asthmatic patients and there is also a validated version for children [11]. It is accepted that a score lower than 19 indicates poorly controlled asthma.Since its validation and publication, ACT has been used extensively in clinical trials, mainly because it allows a more "objective" evaluation of asthma control than that performed by the physician during a "spot" visit [11-13]. Moreover, it has been demonstrated that patients also tend to overestimate the level of
Clinically diagnosed childhood asthma and follow-up of symptoms in a Swedish case control study
Eduardo Roel, ?shild Faresj?, Olle Zetterstr?m, Erik Trell, Tomas Faresj?
BMC Family Practice , 2005, DOI: 10.1186/1471-2296-6-16
Abstract: In a defined region in Sweden with a population of about 150 000 inhabitants, all children (n = 2 104) born in 1990 were recorded. At the age of seven all primary care and hospital records of the 1 752 children still living in the community were examined, and a group of children (n = 191) was defined with a well-documented and medically confirmed asthma diagnosis. At the age of ten, 86 % of these cases (n = 158) and controls (n = 171) completed an ISAAC questionnaire concerning asthma history, symptoms and related conditions.Different types of asthma symptoms were highly and significantly over-represented in the cases. Reported asthma heredity was significantly higher among the cases. No significant difference in reported allergic rhinitis or eczema as a child was found between cases and controls. No significant difference concerning social factors or environmental exposure was found between case and controls. Among the control group 4.7 % of the parents reported that their child actually had asthma. These are likely to be new asthma cases between the age of seven and ten and give an estimated asthma prevalence rate at the age of ten of 15.1 % in the studied cohort.A combination of medical verified asthma diagnosis through medical records and the use of self-reported symptom through the ISAAC questionnaire seem to be valid and reliable measures to follow-up childhood asthma in the local community. The asthma prevalence at the age of ten in the studied birth cohort is considerably higher than previous reports for Sweden. Both the high prevalence figure and allowing the three-year lag phase for further settling of events in the community point at the complementary roles of both hospital and primary care in the comprehensive coverage and control of childhood asthma in the community.In the last decades, childhood asthma has risen dramatically and now forms a major and still increasing health problem, notably but not exclusively in the affluent parts over the world [1-4]
Asthma Control Test and Asthma Quality of Life Questionnaire Association in Adult Asthmatics
Aylin Ozgen Alpaydin,Mine Bora,Arzu Yorgancioglu,Aysin Sakar Coskun
Iranian Journal Of Allergy, Asthma and Immunology , 2012,
Abstract: Asthma control and quality of life are expected to be correlated. We aimed to evaluate the association of asthma control test (ACT) with asthma quality of life questionnaire (AQLQ) and guideline based control assessment. We also aimed to investigate the impact of therapy adjustment according to ACT score on AQLQA total of 101 asthmatic patients were included. ACT, AQLQ and Global Initiative for Asthma (GINA) based control assessments were performed. Based on ACT, treatment was adjusted by stepping down in controlled and stepping up in uncontrolled/partly controlled patients. In some controlled/partly controlled patients, no therapy adjustment was done. After 3-months the same parameters were reevaluated.We found a statistically significant association between ACT and AQLQ, a one point increase in ACT was associated with a 0.129 point increase in AQLQ. ACT scores increased significantly in the step-up group; however AQLQ total scores were not affected after therapy adjustment. We found that ACT was concordant with GINA recommended control classification in the first (kappa=0.511, 7.718) and third months (kappa=0.599, 7.912) (p<0.001 for both).We determined an association between ACT and AQLQ. ACT was also found fairly concordant with GINA. However, treatment adjustment according to ACT was not found satisfactory in terms of quality of life.
Childhood asthma prevalence and parents’ daily cigarette smoking: a case - control study
Sharifi L,Pourpak Z,Bokaie S,Karimi A
Tehran University Medical Journal , 2009,
Abstract: "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Asthma prevalence has increased in developed and developing countries in several last decades. Although cigarette smoking is an identified risk factor for many diseases such as coronary Heart disease and chronic obstructive lung disease, its effect on asthma is controversial. The aim of this study was to determine the odds ratio and its confidence interval for asthma morbidity among children referred to the Immunology and Allergy department of children medical center according to their parents' smoking and daily cigarette consumption."n"nMethods: A case-control study was conducted during two years period on the asthmatic patients who referred to Immunology and Allergy department of children medical center. Demographic information and parents' smoking and daily cigarette consumption assessed by a questionnaire. Healthy children with same age and sex were entered to the study as the control group. Statistical analysis was performed to calculate odds ratio."n"nResults: Among 215 patients who entered the study 63 patients were exposed the cigarette smoke. Odds ratio for asthma morbidity among children whose parents smoke more than five cigarettes per day in comparison with whose smoke less than five or do not smoke was 2.38 (p<0.01)."n"nConclusion: Parent's cigarette smoking is a risk factor for childhood asthma and could increase the risk of asthma to 2.38 folds in children whose parents smoke more than five cigarettes. Increasing in parents' knowledge level that probably relate to their education results in cigarette consumption decline.
Childhood asthma
M Levin, E Weinberg
South African Family Practice , 2011,
Abstract: Asthma is the most common chronic disease of South African children, affecting growth and development and quality of life. Features supporting the diagnosis are a family or personal history of atopy, night cough, exercise-induced cough and/or wheeze and seasonal variation in symptoms. Asthma is on the increase in both developed and developing countries, in both rural and urban communities. The first part of this series aims to give a brief overview of the epidemiology, pathophysiology and diagnosis of childhood asthma.
Control of Allergic Rhinitis and Asthma Test (CARAT) can be used to assess individual patients over time
Joao A Fonseca, Luis Nogueira-Silva, Mario Morais-Almeida, Ana Sa-Sousa, Luis F Azevedo, Jose Ferreira, Manuel Branco-Ferreira, Rodrigo Rodrigues-Alves, Antonio Bugalho-Almeida, Jean Bousquet
Clinical and Translational Allergy , 2012, DOI: 10.1186/2045-7022-2-16
Abstract: Adults with asthma and allergic rhinitis were enrolled at 4 outpatient clinics of Portuguese central hospitals. At each of the two visits, 4 to 6 weeks apart, patients filled out CARAT10 and additional questionnaires, followed by a medical evaluation blinded to the questionnaires’ answers.From the 62 patients included, 51 patients completely filled out CARAT10 at both visits. The test-retest reliability, computed as an intra-class correlation coefficient, was 0.82. Regarding responsiveness, a significant change (p?=?0.002) of CARAT10 score in clinically unstable patients was observed (95%CI -5.08; -1.31) and the Guyatt’s responsiveness index was 1.54. As for the longitudinal validity assessment, the correlation coefficients of the changes of CARAT10 scores with those of ACQ5 and symptoms VAS ranged from 0.49 to 0.65, while with the physician assessment of control they ranged from 0.31 to 0.41.CARAT10 has good test-retest reliability, responsiveness and longitudinal validity. It can be used to assess control of allergic rhinitis and asthma, both to compare groups in clinical studies and to evaluate individual patients in clinical practice.Rhinitis and asthma are highly prevalent diseases that are closely associated. A few questionnaires have been developed and validated to assess the control of rhinitis [1,2] and asthma [3,4]. For over a decade, the Allergic Rhinitis and its Impact on Asthma (ARIA) initiative has recommended the simultaneous assessment and management of these diseases [5,6]. Recent observational studies reinforced the association of rhinitis and asthma. In a cross-sectional study of asthma patients from 85 primary care practices in the United Kingdom, self-reported rhinitis was identified as a major predictor of poor asthma control [7]. Also, data from the West Sweden Asthma Study linked the degree of rhinitis with the risk of having multi-symptom asthma [8].We have previously developed the Control of Allergic Rhinitis and Asthma Test – a 17-item ver
Utilization and responsiveness of the asthma control test (ACT) at the initiation of therapy for patients with asthma: a randomized controlled trial
Mohamed S Al Moamary, Ahmed G Al-Kordi, Mohammed O Al Ghobain, Hani M Tamim
BMC Pulmonary Medicine , 2012, DOI: 10.1186/1471-2466-12-14
Abstract: This study was designed as a randomized clinical trial conducted in a primary care setting. The subjects were asthma patients who had not received controller therapy for at least two months. The patients were randomized into two groups: The Saudi Initiative for Asthma (SINA) group and the Global Initiative for Asthma (GINA) group. Treatment in the SINA group was initiated at step1 when the ACT scores ≥ 20, step 2 when the score between16-19, and step 3 when the score < 16 began at step 3. The GINA group patients were started on step 2 when they had persistent asthma symptoms or step 3 when they had severely uncontrolled disease.Forty-five patients were analyzed in each group. The improvement in ACT score after treatment initiation was significantly higher when the SINA approach was used (2.9 in the SINA group compared to 1.7 in the GINA group (p = 0.04)). The improvement in FEV1 was 5.8% in the SINA group compared to 3.4% in the GINA group (p = 0.46). The number of patients who achieved asthma control at the follow-up visit and required no treatment adjustment was 33 (73.3%) in the SINA group and 27 (60%) in the GINA group (p = 0.0125).The ACT was responsive to change at the initiation of asthma treatment and was useful for the initiation of asthma treatment.ISRCTN31998214The Global Initiative for Asthma (GINA) has evolved management from being based on a severity index to the concept of achieving asthma control [1-4]. It has adopted a five-step approach to control asthma, where each step represents a different treatment option with increasing efficacy. The five-step approach is designed to maintain control with the least amount of medication [1,5]. For the initiation of treatment, the GINA recommended step 2 for most treatment na?ve patients with persistent symptoms, while step 3 was recommended for severely uncontrolled disease [1]. The National Asthma Education and Prevention Program (NAEPP) is another major guideline that utilized asthma severity categorization
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