Comparing asthma control assessment using the Asthma Control Test and the Asthma APGAR in African American/Black and Hispanic/Latinx populations

Abstract

Introduction

The objective of this analysis was to compare the Asthma Control Test (ACT) and the Asthma APGAR asthma control assessment tools in African-Ancestry/Black (AA/B) and Hispanic/Latinx (H/L) adults with moderate to severe asthma.

Methods

This pre-planned sub-study of the PREPARE clinical trial compares the baseline ACT and Asthma APGAR scores for the PREPARE populations using correlation coefficients, generalized linear modeling and receiver operating curve (ROC) analyses. Correlations were also assessed for both control tests and the Asthma Symptom Utility Index (ASUI).

Results

Among the 1201 adults (603 AA/B and 598 H/L) with moderate to severe asthma, most had uncontrolled asthma by both the ACT and the Asthma APGAR. Correlation coefficients between the ACT, Asthma APGAR and ASUI were strong and did not differ significantly by race/ethnicity. The ACT consistently assessed more patients as uncontrolled compared with the Asthma APGAR. The differences in ACT and Asthma APGAR scores did not differ by age, gender, race/ethnicity, self-reported health literacy or medication adherence but did differ by education level. Both the ACT and Asthma APGAR had similar ROCs for predicting an asthma exacerbation in the next 3 months.

Conclusions

Both the ACT and the Asthma APGAR can be used for asthma control assessment in AA/B and H/L populations with moderate to severe asthma, providing comparable rates of uncontrolled asthma and similar limited ability to predict exacerbations. Further work is required to better understand the basis and clinical implications of the higher rates of uncontrolled asthma identified using the ACT.

Keywords:

• Asthma
• asthma control
• adults
• Black
• Hispanic
• pragmatic study

Acknowledgements

All the statements in this article, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or its Methodology Committee.

The authors acknowledge the important work of the PREPARE team including Juan Carlos Cardet, MD, Jennifer Carroll, MD, Maureen Fagan PhD and Victoria Place, PA as well as all clinical sites and staff and participants who enrolled in the parent study.

Declaration of interest

Dr. B Yawn, MS. B Erickson, Dr. Jing Cui, and Dr. A Fuhlbrigge designed the study, oversaw data collection, either completed or reviewed all analysis, either wrote or provided critical review for the manuscript and had full access to all study data.

Dr. E Israel, Ms. N Maher and Dr. W. Pace helped design the study, oversaw data collection and provided critical review for the manuscript.

Dr. E. Israel obtained funding for the work.

Additional information

Funding

Study was supported by a PCORI Award (PCS-1504–30283, to Dr. Israel), the Gloria M. and Anthony C. Simboli Distinguished Chair in Asthma Research award (to Dr. Israel). QVAR and QVAR RediHaler inhalers were provided free of charge and funding for the AssistRx pharmacy was provided by Teva pharmaceuticals. NIOX VERO devices for measuring exhaled nitric oxide were provided free of charge by Circassia Pharmaceuticals.