• Vol. 38 No. 12, 1064–1069
  • 15 December 2009

Was it Easy to Use an Asthma Control Test (ACT) in Different Clinical Practice Settings in a Tertiary Hospital in Singapore?



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Introduction:The Asthma Control Test TM (ACT) is a 5-item self-administered tool designed to assess asthma control. It is said to be simple, easy and can be administered quickly by patients in the clinical practice setting. This stated benefit has yet to be demonstrated in our local clinical practice setting. The aim was to identify factors associated with difficulty in the administration of the ACT in different clinical practice settings in a tertiary hospital in Singapore. Materials and Methods: This is a prospective study performed from April to June 2008. All patients diagnosed with asthma and referred to an asthma nurse from the in-patient and out-patient clinical practice setting in Tan Tock Seng Hospital were enrolled. Results: Four hundred and thirty-four patients were asked to complete the ACT tool. In the univariate model, we found that age, clinical setting and medical history to be significantly associated with the completion of the ACT. The odds of completion decreased by a factor of 0.92 (95% CI, 0.89 to 0.94) for every year’s increase in age, and this was statistically significant (P <0.001). Similarly, the odds ratio of completion for those with more than 3 medical conditions by history were 0.59 (95% CI, 0.48 to 0.71) as compared to those with less than 3 medical conditions by history, and this was also significant (P <0.001). In the multivariate model, we only found age to be an independent and significant factor. After adjusting for age, none of the other variables initially significant in the univariate model remained significant. Conclusion: The results show that the ACT was simple and easy to be administered in younger-aged patients.

In Singapore, asthma is a very common problem. It is estimated that 140,000 individuals in Singapore have current asthma, with a prevalence as high as 20% among school children,1 and 5% among the adult population.2 The increasing trend in the prevalence of asthma and its personal and societal tolls continue not only in Singapore but internationally.3 This is despite the advances in knowledge about the pathophysiology of asthma and the availability of effective therapy. Current asthma guidelines have shifted their focus from managing acute attacks to achieving and maintaining asthma control for prolonged periods.3 It has been stated that inadequate assessment of asthma control is an important contributing factor for poor asthma control.4 While validated tools have been developed previously to assess and quantify asthma controls, such as asthma control questionnaire (ACQ), 5 asthma control scoring systems6 and asthma therapy assessment questionnaire (ATAQ),7 they have various limitations in terms of their clinical usage like complicated scoring, difficulty in interpretation, validated in certain populations only, requires lung function testing that may be expensive and impractical for a typical clinical setting.8 To facilitate the assessment of asthma control in a busy clinical practice setting, we needed a tool that is easily and quickly administered and interpreted by patients and clinicians. The Asthma Control Test (ACT) was developed to meet these needs.8 It has been cited in GINA3 as having “the potential to improve the assessment of asthma control, providing a reproducible objective measure that may be charted over time and representing an improvement in communication between patient and healthcare professional”. The ACT is a 5-item self-administered tool that is stated to be simple, easy and can be quickly administered by patients in different clinical settings. The stated benefits have yet to be demonstrated in our setting with Singapore being a multi-racial, multi-ethnic nation. The aim of this study was to assess if the ACT was easy to use in a tertiary hospital in Singapore. This study aimed to identify factors associated with difficulty in administering the ACT in 2 clinical practice settings.

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