Assessing asthma control: comparison of electronic-recorded short-acting beta-agonist rescue use and self-reported use utilizing the asthma control test

Abstract

Background: Question 4 (Q4) of the Asthma Control Test (ACT) asks patients to report their SABA use over the prior 4 weeks, a criterion for evaluating the impairment domain of asthma control. Biases in recall may lead to a misclassification of asthma control and has implications for asthma control determination and management strategies.

Objective: To correlate objective electronic-recorded short-acting beta-agonist (SABA) use with self-reported use via Q4 of the ACT.

Methods: Patients ≥18 years of age with a self-reported diagnosis of asthma were enrolled in a digital health electronic medication monitoring (EMM) platform, which recorded the date and time of SABA actuations and prompted the completion of the ACT. The correlations between ACT Q4 responses and EMM-recorded SABA use were evaluated using Spearman’s rank correlation coefficients.

Results: 1,062 patients (mean age: 35.4 years, mean ACT: 16.3) were included in analyses. Higher Q4 scores, indicating lower SABA use, were moderately and negatively correlated with EMM-recorded SABA use (ρ = -0.59 [95% CI: -0.63, -0.54]). Thirty-five percent of patients underreported SABA use when comparing Q4 to EMM-recorded SABA use.

Conclusions: While ACT Q4 and EMM-recorded use were moderately correlated, underreported SABA use on the ACT highlights the need for objective measures of SABA use in asthma control assessments. The use of EMM-recorded SABA data has the potential for clinicians to more accurately determine asthma control, guide changes to controller therapy, and estimate imminent exacerbation risk.

Keywords:

• Control/management
• management/control
• epidemiology

Acknowledgements

Authors thank Connelly Doan for his contribution in analysis.

Declaration of interest

W. Anderson has served as a consultant for Astra Zeneca. R. Gondalia, L. Kaye, M. Barrett, and D. Stempel report compensation from their employer, Propeller Health. H. Hoch has served as a consultant for Astra Zeneca; has received EMMS from Propeller Health for other research studies; received a loan repayment grant from the NIH; and study funding from the Colorado Department of Public Health and Environment, as well as Children’s Hospital Colorado. S. Szefler has served as a consultant for Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Aerocrine, Astra Zeneca, Daiichi Sankyo, Roche, Teva, Propeller Health, Sanofi, and Regeneron; and received grants from GlaxoSmithKline.

Additional information

Funding

This study was supported by Propeller Health.