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The Asthma Control Test (ACT): Does It Reliably Assess Asthma Control in African American Adolescents with Persistent Asthma?
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Allison J. Burbank, MD, Katherine Mills, BA, Haibo Zhou, PhD, Qingning Zhou, Michelle L. Hernandez, MD
Rationale: Measurement properties of the Asthma Control Test (ACT) are lacking in adolescent asthmatics, particularly among African Americans who may under-report asthma symptoms and experience more asthma-related morbidity and mortality. 

Methods: We propose that the accepted ACT scores used to determine asthma control would have poor agreement with physician assessment of control in African American adolescents. We conducted an ongoing prospective study of African American children ages 12-18 with persistent asthma. After completing the ACT and spirometry, the physician (blinded to ACT score) performed a standardized assessment of asthma control. Agreement of an ACT score > 19 with physician assessment of control was used to measure sensitivity, specificity, and Cohen κ.

Results: Data for 22 subjects who completed at least one visit were included in the analysis. Using a cut point of > 19 for asthma control, the ACT and physician’s assessment were somewhat in agreement (κ=0.374, p=.08). In addition, a cut point of > 19 had a sensitivity of 77.8% and specificity of 61.5% in this population.

Conclusions: Our results show only a fair level of agreement between ACT score and physician assessment of asthma control in African American adolescents with persistent asthma. While not statistically significant, our data suggest that our effect size could be significant, but a larger sample size is needed in order to reach significance. The cut off score of 19 was less specific for determining asthma control in African American teens compared to previous studies of ACT accuracy in Caucasian adults.