Confirming Validity of the Childhood Asthma Control Test

Researchers from the Department of Medicine, Section of General Internal Medicine at the University of Chicago evaluated the validity of the Childhood Asthma Control Test (C-ACT) and sought to determine effective thresholds for uncontrolled asthma in pediatric patients. Their findings were published in Pediatric Pulmonology.

According to the study’s lead author, Francesca Chu, the C-ACT tool had “good internal consistency and mixed levels of agreement and correlation with various clinical asthma measures.” In addition, the investigators noted thresholds for asthma control did not show any associations with nationality, race, ethnicity, or language.

C-ACT Tool Proves Valid for Pediatric Asthma Populations

Researchers selected 28 studies for meta-analysis in a systematic review of PubMed, Ovid Medline, Scopus, CINAHL, and conference records. Studies were eligible if they enrolled pediatric patients with asthma, had a primary end point of asthma control, examined test validity or psychometrics, and used the C-ACT.

The included reports were published between 2007 and 2018, and enrolled an average of 193 ± 155 patients (range, 22-671). Based on 10 studies, researchers calculated a mean Cronbach’s alpha of 0.78 ± 0.05 (range, 0.677-0.83). The authors also noted that 13 of the studies recommended thresholds for uncontrolled asthma from ≤18 to ≤24.

Of note, 9 of the studies observed a significant agreement or correlation between C-ACT values and Global Initiative for Asthma (GINA) guidelines for physician assessment of asthma control (correlation coefficients range, 0.219-0.65). Finally, authors reported that C-ACT and spirometry had a correlation coefficient <0.06 in 5 out of 6 studies that evaluated spirometry, and kappa values for C-ACT and various spirometry parameters ranged from 0 to 0.34.

In closing, Chu and colleagues supported the validity of the C-ACT tool, though they noted that recommended cut-offs for asthma control were inconsistent, and cautioned that “few studies examined cross-cultural validity and multiple populations remain under-studied.”

Find Related Reports on the Asthma Resource Center