الفهرس 
Factors influencing the Development and Expression of AsthmaOnly 14 pages are availabe for public view
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Abstract
Asthma is a serious global health problem. People of all
ages in countries throughout the world are affected by this chronic airway disorder that when uncontrolled can place severe limits
on daily life and is sometimes fatal.
Uncontrolled asthma still engenders nearly 500,000 hospitalizations and more than 4,000deaths annually. Disconcertingly, almost 40% of the asthma-related hospitalizations occur in children under the age of 15 years. In addition, the direct and indirect costs associated with asthma treatment now total about $ 16 billion annually, with the costs associated with uncontrolled asthma about twice that for controlled asthma.
Studies show that improved control of asthma is associated
with reduced healthcare resource utilization and reduced costs to healthcare providers and society compared with poorly controlled disease.
A simple tool is required to assess asthma control accurately.
The tool needs to be quick to use in primary care, where the majority of patients with asthma are managed by a range of healthcare professionals, in brief consultations.
Thus, the present study aimed to compare ACT with spirometry in asthmatic patients to evaluate the role of ACT in assessment of asthma control.
So, this study included 100 asthmatic patients over 12 years old, with none exacerbated asthma and able to complete all the questionnaire. They were collected from the out patient clinic of the National Center for Allergy and Chest Researches (Imbaba).
All patients were subjected to a full medical history,
clinical examination, posteroanterior chest x-ray, and
spirometry after they had completed the ACT questionnaire.
The ACT is a 5-item survey that assesses interference with activity, shortness of breath, nocturnal symptoms,
rescue medication and self-rating of asthma control.
Each question was rated on a 5-point scale. A total score
was obtained by summing of the 5 scores. A total of 25 points indicated complete control, from 20-24 good control and less than 20 points out of control.
Then asthma severity and asthma control of each patient were rated according to the GINA (2006) guidelines.
Results of the present study found that there was a highly positive correlation between ACT and spirometric results
especially FEV1% in defined uncontrolled asthmatic patients.
Therefore, the ACT is an easily administered and scored survey that measures asthma control accurately and it is
more suitable in busy clinical practice, especially in those
hospitals without spirometric equipment.
Also the present study showed that a large proportion of patients with FEV1 equal or higher than 80 % of predicted
value might be out of control according to ACT survey.
So, the use of FEV1 alone might be misleading as an indicator of asthma control especially if the patients were under
bronchodilator treatment.
Also, it was demonstrated that there was a higher correlation between ACT and doctor’s rating of asthma control (based
on GINA 2006 guidelines) than between the percentage of
the predicted FEV1value and doctor’s rating of asthma control.
So, if spirometry is available, the best measure of control will be a combination of both ACT and FEV1 to identify
uncontrolled asthmatic patients.
This study was demonstrated that ACT total scores differed significantly across the groups of patients with varied levels of the percentage of the predicted FEV1values as it improved among patient groups whose asthma control improved, as defined by changes in the predicted FEV1% values.
So, ACT could be used as an easily and simple method to monitor asthma control of asthmatic patients in their routinely visits.
In the present study, there was highly correlation between the patient’s self rating and the doctor’s rating of level of asthma control.
Furthermore, using ACT might improve communication between patients and physicians, which would improve physician’s performance, patient’s satisfaction and therapeutic outcomes
So, in their management, asthmatic patients should be further educated about asthma to enhance the accuracy of ACT survey.
Recommendation
It is possible to improve current levels of asthma control if healthcare professionals do four things:
1. Use appropriate, patient-centered tools to assess control.
2. Identify the reasons for poor control in individual patients.
3. Work with patients to design individual treatment plans that address poor control and the causes of poor control, taking account of patient goals and aspirations.
4. Monitor outcomes and take appropriate action through regular review.
The ACT survey should facilitate efforts to improve assessment of the level of asthma control in the busy clinical practice setting, with or without the use of spirometry.
If spirometry is available, it will be better to use both the ACT and FEV1 to identify uncontrolled asthmatic patients as the use of FEV1 alone may be misleading as an indicator of asthma control especially in patients taking bronchodilator medications.
ACT could be used as an easily and simple method to monitor asthma control of asthmatic patients in their routinely visits.
In their management, asthmatic patients should be further educated about asthma to enhance the accuracy of ACT survey.
Several questions remain to be answered by future studies as if further use of ACT will produce an improvement in the prevention and treatment of asthma, if we can use childhood ACT to assess asthma control in children less than 12 years old. if we can compare ACT with inflammatory markers in the assessment of asthma control.