Comparability of asthma control test scores between self and physician-administered test

Background: The Asthma Control Test (ACT) is a tool that allows physicians to estimate the control of asthma symptoms on each patient in a quick way. Methods: We conducted a prospective single-center observational study enrolling 97 patients with asthma, selected from the Outpatient Respiratory Service of “Policlinico-Vittorio Emanuele” in Catania. Patients answered the ACT in full autonomy. Subsequently, the physician, blinded to the previous ACT evaluation, administered a new ACT and then assessed patients' medical condition during his/her visit. A second physician evaluated patients’ level of symptom control according to GINA guidelines. Agreement in ACT score was analyzed using the Kendall coefficient of concordance (W) for ACT individual items and overall score. The impact of different education levels on the ACT was analyzed with the Mann-Whitney test. Main findings: There was no significant difference in ACT total score obtained by either administration mode (p > 0.05). Responses to ACT single items showed a statistically significant difference between patients with lower and higher education levels in ACT items n°3 and 5, (p < 0.05), with lower education levels influencing patients symptom perception and disease control. Moreover, a significant difference in the evaluation of asthma control was found between ACT and GINA assessment of symptom control (p < 0.05).