Assessing asthma control: comparison of electronic-recorded short-acting beta-agonist rescue use and self-reported use utilizing the asthma control test
Anderson W, Gondalia R, Hoch H, et al.
J Asthma. 2019;9:1–5
The increased use of short-acting beta-agonists (SABA) in adults and adolescents with asthma is correlated with suboptimal disease control and is an independent predictor of exacerbations. The National Heart, Lung, and Blood Institute National Asthma Education and Prevention Program Expert Panel 3 (EPR-3) defines not well-controlled asthma as SABA use on >2 days per week and defines very poorly controlled asthma as SABA use several times per day. The Global Initiative for Asthma (GINA) defines uncontrolled asthma based on SABA use more than twice per week. The Asthma Control Test (ACT) provides a validated assessment of control. Question 4 (Q4) of the ACT asks patients to report how many times over the previous 4 weeks they have administered SABA. However, imprecise or biased recall of past SABA use could lead to a misclassification of patients. The aim of this study was to determine whether all 5 questions of the ACT are required or whether Q4 is sufficient to evaluate patient control of asthma.
1,062 adults with a self-reported diagnosis of asthma were enrolled in a digital health electronic medication monitoring (EMM) platform. The EMM platform automatically recorded the date and time of SABA administrations and prompted completion of the ACT. Higher ACT Q4 scores, indicating lower SABA use, were negatively correlated with actual SABA use as recorded on the EMM (p=-0.59). 35% percent of patients underreported SABA use when comparing Q4 to EMM-recorded SABA use.
The high rates of underreporting in this study highlight the need for objective measures of SABA use in asthma control assessments. The ability of EMMs to provide passively collected objective data minimises potential recall error. Therefore, the use of EMM-recorded SABA data has the potential to enable more accurate assessment of asthma control, guide possible changes to treatment and estimate short-term exacerbation risk. This study adds to our understanding of the relationship between self-reported and objective SABA use, and may be helpful when incorporated into clinical practice.