Original Article
Relationship of the Asthma Control Test (ACT) with Lung Function, Levels of Exhaled Nitric Oxide and Control According to the Global Initiative for Asthma (GINA)
Relación del test de control del asma (ACT) con la función pulmonar, niveles de óxido nítrico exhalado y grados de control según la Iniciativa Global para el Asma (GINA)
Francisco Javier Álvarez-Gutiérreza,
, Juan Francisco Medina-Gallardoa, Pablo Pérez-Navarroa, Juan José Martín-Villasclarasb, Bernardo Martin Etchegorenc, Beatriz Romero-Romerod, Juan Manuel Praena-Fernándeze
Corresponding author
a Unidad de Asma CE Fleming, UMQER, Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Servicio de Neumología, Hospital Carlos Haya, Málaga, Spain
c Servicio de Neumología, Hospital San Cecilio, Granada, Spain
d Servicio de Neumología, Hospital San Juan de Dios, Bormujos, Sevilla, Spain
e Unidad de Metodología y Evaluación de Investigación, Fundación Pública Andaluza para la Gestión de la Investigación en Salud, HU, Virgen del Rocío, Sevilla, Spain
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Pérez-Navarro, Juan José Martín-Villasclaras, Bernardo Martin Etchegoren, Beatriz Romero-Romero, Juan Manuel Praena-Fernández" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Francisco Javier" "apellidos" => "Álvarez-Gutiérrez" "email" => array:1 [ 0 => "franciscoalvarez@neumosur.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan Francisco" "apellidos" => "Medina-Gallardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Pablo" "apellidos" => "Pérez-Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Juan José" "apellidos" => 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] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Carlos Haya, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neumología, Hospital San Cecilio, Granada, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Neumología, Hospital San Juan de Dios, Bormujos, Sevilla, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Metodología y Evaluación de Investigación, Fundación Pública Andaluza para la Gestión de la Investigación en Salud, HU, Virgen del Rocío, Sevilla, Spain" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Relación del test de control del asma (ACT) con la función pulmonar, niveles de óxido nítrico exhalado y grados de control según la Iniciativa Global para el Asma (GINA)" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-01-18" "fechaAceptado" => "2010-04-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec156078" "palabras" => array:6 [ 0 => "Asthma" 1 => "Asthma Control Test (ACT)" 2 => "Control" 3 => "Questionnaire" 4 => "GINA (Global Initiative for Asthma)" 5 => "Fractionated exhaled nitric oxide (FeNO)" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec156077" "palabras" => array:6 [ 0 => "Asma" 1 => "Asthma Control Test (ACT)" 2 => "Control" 3 => "Cuestionarios" 4 => "GINA (Global Initiative for Asthma)" 5 => "Óxido nítrico exhalado (FeNO)" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The current goal of asthma treatment is to achieve and maintain control. This study aimed to explore the relationship between the ACT (Asthma Control Test) questionnaire and the levels of control according to GINA (Global Initiative for Asthma) to establish the cut-off points for the ACT and evaluate its relationship with lung function and fractionated exhaled nitric oxide level (FeNO).</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A multi-centre prospective study including 441 patients followed up in an outpatient Chest Clinic. A clinical protocol was followed, and FeNO, spirometry and ACT performed. Disease was classified according to levels of control using GINA. The study analysed sensitivity, specificity and area under the curve (ROC), and the ACT cut-off points. We studied the differences between the functional parameters and FeNO between levels of control.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">For controlled asthma the cut-off obtained was ACT≥ 21 (area under the curve 0.791) and for uncontrolled ≤ 18 (AUC 0.774). We found significant differences in FeNO levels and pulmonary function among ACT≥ 21 and ACT ≤ 18, although only 26.3% of patients with ACT≤ 18 had a FEV1 <80% and 40% higher FeNO (≥ 35 ppb). We found a correlation between baseline FEV1 and ACT (<span class="elsevierStyleItalic">r</span> = 0.19, <span class="elsevierStyleItalic">P</span> < 0.01) and between ACT and FeNO (<span class="elsevierStyleItalic">r</span> = -0.16, <span class="elsevierStyleItalic">P</span> < 0.01).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The cut-off points would be, for controlled asthma ACT≥ 21, partly controlled asthma ACT = 19-20 and uncontrolled asthma ACT ≤ 18. A more complete assessment would require including monitoring operating parameters and FeNO.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo actual en el tratamiento del asma es conseguir y mantener el control. Este estudio tiene como objetivos estudiar la relación entre el cuestionario ACT (Asthma Control Test) y los niveles de control según Global Initiative for Asthma para establecer los puntos de corte del ACT y evaluar su relación con la función pulmonar y la Fracción exhalada de óxido nítrico (FeNO).</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo multicéntrico con inclusión de 441 pacientes seguidos en consultas externas de neumología. Se realizó protocolo clínico, FeNO, espirometría forzada y ACT. Se clasificó la enfermedad según los niveles de control de la Global Initiative for Asthma. Se realizó estudio de sensibilidad, especificidad y área bajo la curva (ROC), estimándose los puntos de corte de ACT. Se estudiaron las diferencias entre los parámetros funcionales y FeNO entre los niveles de control.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Para el asma controlada el punto de corte obtenido fue ACT ≥ 21 (área bajo la curva 0,791) y para el no controlada fue ≤ 18 (área bajo la curva 0,774). Encontramos diferencias significativas en niveles de FeNO y función pulmonar entre ACT ≥ 21 y ACT ≤ 18, aunque solo el 26,3% de pacientes con ACT ≤ 18 presentaron un FEV1 < 80% y el 40% FeNO elevado (≥ 35 ppb). Encontramos correlación entre FEV1 basal y ACT (r = 0,19, p < 0,01), así como entre ACT y FeNO (r = -0,16, p < 0,01).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los puntos de corte para el asma controlada serían ACT ≥ 21, para el asma parcialmente controlada ACT = 19-20 y para el asma no controlada ACT ≤ 18. Una valoración más completa del control requeriría incluir parámetros funcionales y FeNO.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Global Initiative for Asthma Global strategy for asthma management and prevention. Available from: <a class="elsevierStyleInterRef" href="http://www.ginasthma.com/">http://www.ginasthma.com</a>. Accessed Janvier 14, 2010." ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of the asthma control test: a survey for assesing asthma control" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.A. Natham" 1 => "Ch.A. Sorkness" 2 => "M. Kosinski" 3 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 4 | 7 |
| 2024 October | 40 | 17 | 57 |
| 2024 September | 32 | 27 | 59 |
| 2024 August | 46 | 51 | 97 |
| 2024 July | 25 | 31 | 56 |
| 2024 June | 38 | 40 | 78 |
| 2024 May | 47 | 46 | 93 |
| 2024 April | 22 | 33 | 55 |
| 2024 March | 24 | 22 | 46 |
| 2024 February | 17 | 30 | 47 |
| 2023 March | 4 | 7 | 11 |
| 2023 February | 25 | 19 | 44 |
| 2023 January | 16 | 26 | 42 |
| 2022 December | 26 | 27 | 53 |
| 2022 November | 20 | 20 | 40 |
| 2022 October | 20 | 46 | 66 |
| 2022 September | 16 | 17 | 33 |
| 2022 August | 19 | 36 | 55 |
| 2022 July | 25 | 36 | 61 |
| 2022 June | 16 | 26 | 42 |
| 2022 May | 18 | 31 | 49 |
| 2022 April | 18 | 26 | 44 |
| 2022 March | 34 | 34 | 68 |
| 2022 February | 18 | 26 | 44 |
| 2022 January | 45 | 34 | 79 |
| 2021 December | 50 | 54 | 104 |
| 2021 November | 41 | 59 | 100 |
| 2021 October | 26 | 60 | 86 |
| 2021 September | 16 | 59 | 75 |
| 2021 August | 25 | 31 | 56 |
| 2021 July | 13 | 26 | 39 |
| 2021 June | 25 | 48 | 73 |
| 2021 May | 15 | 26 | 41 |
| 2021 April | 32 | 91 | 123 |
| 2021 March | 40 | 31 | 71 |
| 2021 February | 12 | 27 | 39 |
| 2021 January | 15 | 20 | 35 |
| 2020 December | 22 | 21 | 43 |
| 2020 November | 16 | 25 | 41 |
| 2020 October | 10 | 5 | 15 |
| 2020 September | 9 | 7 | 16 |
| 2020 August | 15 | 23 | 38 |
| 2020 July | 20 | 15 | 35 |
| 2020 June | 19 | 1 | 20 |
| 2020 May | 23 | 15 | 38 |
| 2020 April | 24 | 18 | 42 |
| 2020 March | 13 | 11 | 24 |
| 2020 February | 16 | 22 | 38 |
| 2020 January | 26 | 23 | 49 |
| 2019 December | 19 | 17 | 36 |
| 2019 November | 20 | 23 | 43 |
| 2019 October | 16 | 7 | 23 |
| 2019 September | 16 | 21 | 37 |
| 2019 August | 22 | 20 | 42 |
| 2019 July | 15 | 27 | 42 |
| 2019 June | 5 | 23 | 28 |
| 2019 May | 12 | 22 | 34 |
| 2019 April | 14 | 27 | 41 |
| 2019 March | 12 | 27 | 39 |
| 2019 February | 7 | 25 | 32 |
| 2019 January | 0 | 31 | 31 |
| 2018 December | 11 | 15 | 26 |
| 2018 November | 18 | 30 | 48 |
| 2018 October | 12 | 22 | 34 |
| 2018 September | 10 | 16 | 26 |
| 2018 May | 6 | 0 | 6 |
| 2018 April | 12 | 5 | 17 |
| 2018 March | 9 | 6 | 15 |
| 2018 February | 4 | 6 | 10 |
| 2018 January | 10 | 9 | 19 |
| 2017 December | 7 | 12 | 19 |
| 2017 November | 1 | 8 | 9 |
| 2017 October | 8 | 17 | 25 |
| 2017 September | 5 | 19 | 24 |
| 2017 August | 8 | 25 | 33 |
| 2017 July | 10 | 15 | 25 |
| 2017 June | 9 | 32 | 41 |
| 2017 May | 5 | 12 | 17 |
| 2017 April | 4 | 8 | 12 |
| 2017 March | 4 | 17 | 21 |
| 2017 February | 4 | 6 | 10 |
| 2017 January | 3 | 5 | 8 |
| 2016 December | 7 | 7 | 14 |
| 2016 November | 13 | 11 | 24 |
| 2016 October | 16 | 17 | 33 |
| 2016 September | 11 | 14 | 25 |
| 2016 August | 12 | 8 | 20 |
| 2016 July | 15 | 3 | 18 |
| 2016 March | 6 | 0 | 6 |
| 2016 February | 4 | 0 | 4 |
| 2016 January | 5 | 0 | 5 |
| 2015 December | 4 | 0 | 4 |
| 2015 October | 70 | 20 | 90 |
| 2015 September | 67 | 10 | 77 |
| 2015 August | 70 | 19 | 89 |
| 2015 July | 70 | 10 | 80 |
| 2015 June | 60 | 15 | 75 |
| 2015 May | 81 | 8 | 89 |
| 2015 April | 52 | 11 | 63 |
| 2015 March | 61 | 7 | 68 |
| 2015 February | 41 | 9 | 50 |
| 2015 January | 45 | 3 | 48 |
| 2014 December | 51 | 7 | 58 |
| 2014 November | 48 | 9 | 57 |
| 2014 October | 85 | 11 | 96 |
| 2014 September | 56 | 13 | 69 |
| 2014 August | 62 | 17 | 79 |
| 2014 July | 64 | 11 | 75 |
| 2014 June | 71 | 11 | 82 |
| 2014 May | 79 | 12 | 91 |
| 2014 April | 89 | 12 | 101 |
| 2014 March | 90 | 18 | 108 |
| 2014 February | 77 | 16 | 93 |
| 2014 January | 68 | 12 | 80 |
| 2013 December | 59 | 14 | 73 |
| 2013 November | 50 | 8 | 58 |
| 2013 October | 55 | 15 | 70 |
| 2013 September | 75 | 20 | 95 |
| 2013 August | 65 | 10 | 75 |
| 2013 July | 75 | 21 | 96 |
| 2013 June | 48 | 18 | 66 |
| 2013 May | 48 | 16 | 64 |
| 2013 April | 29 | 6 | 35 |
| 2013 March | 16 | 2 | 18 |
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