What’s The Difference Between The Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT)?

When you visit your doctor, they will likely administer a quick test to gauge how well controlled your asthma is. You may have this presented to you as a form, or your doctor may verbally ask you these questions in what seems like a casual conversation. These short questionnaires provide a standardized way to determine if your asthma is currently under good control, or which areas need to be addressed.

When I was helping with work on the protocol document for an asthma study as the team’s patient investigator, I raised the question of why we were using one of these asthma control quiz formats over the other. I looked into the differences to satisfy my own curiosity—both of what I felt was more relevant to me as a patient, and of why one might be better suited to our study question than the other.

Asthma control test (ACT)

The ACT is a 5 question test to identify the current level of asthma control, reflected from a patient’s memory over the past 4 weeks. The ACT covers the impact of asthma on productivity, at work, home, or school, shortness of breath, all asthma symptoms (including coughing, wheezing, dyspnea, and chest tightness), impact at night (either during sleep or early morning awakenings), frequency of rescue medication use, and your perception of your own asthma control.¹

The ACT is scored from 5 (poorly controlled) to 25 (completely controlled) by ranking each question’s response as a 1-5 score (1 being indicative of increased asthma symptoms or impact of asthma symptoms, 5 being indicative of no impact on daily life per the patient’s perspective) and totaling these points.¹

Asthma control questionnaire (ACQ)

The ACQ, not to be confused with ICQ, the instant messenger of the early 2000s (does that still exist?), is the Asthma Control Questionnaire. The ACQ is a 6 question (7 if your doctor chooses to include an in-office spirometry measurement of FEV1 in your scoring), self-administered test to determine your level of asthma control.²

The ACQ covers nighttime awakenings from asthma, severity of asthma symptoms upon waking in the morning, activity modifications or limitations due to your asthma, shortness of breath, wheezing, and use of a short-acting bronchodilator over the past week. The ACQ asks for recall of only the last week.²

The ACQ is also copyrighted and not as easily accessible as the ACT. It took me a while to find a version online that I could self-administer and self-score (I’ll speak to this near the end of this post). For funded academic research, the ACQ requires a payment to the creator for its use, the fee is less for in-clinic use.³

Checking my asthma control

I’ve been going through a period of admittedly questionable asthma control, and I decided to take both the ACT and ACQ for myself with this knowledge.

My asthma control test

I scored 16 on the five-question ACT. The highest (and best) score is 25. I was informed, "There may be more you and your healthcare provider could do to help control your asthma symptoms." If my score was lower than 15, I was encouraged to "contact my healthcare provider right away."

With that said, I saw my doctor within the previous month, and we agreed my asthma could be better controlled. I was directed to keep doing what I was doing, alter my medication doses per our agreed-upon plan (and hopefully avoid prednisone). I blame the ridiculous amount of rain over here.

My asthma control questionnaire

I scored 1.16 on the six-question ACQ. I omitted the 7th question from my calculation, which uses an in-clinic FEV1 (spirometry lung function) measurement, then calculated the average of the scores.² My score (being between 0.75 and 1.5) ranks as, “Well-controlled (but not ‘confident’). Because of the limitations in accessing the ACQ, it is a lot harder to find data online about this method.

How did my scores match up?

I’d say pretty well, though it’s hard to tell given the dramatic differences in the scoring. The scores are not really comparable, but I’d say that when going for low, 1.16 (of 6) "looks better" than 16 of 25.

Scoring as “Well-controlled (but not ‘confident’)” on the ACQ does seem fairly akin to "not as well controlled as [you] could be," at least from my perspective.

What gives clinicians a better look at my asthma?

I personally feel that the asthma control test gives my doctors a better look at my asthma. As always, your asthma may vary. For me, coughing and dyspnea (shortness of breath) are MUCH better symptom indicators of my control than is wheezing. I often use my rescue inhaler more often than should be used per the asthma control guidelines, so, this is a measurement that I take with a bit of a grain of salt—as do my doctors. Plus with the ACQ being skewed toward the last week, it is better as a short-term indicator of control, rather than long-term, as ACT asks for recall over the last month (which, admittedly, may make it less accurate).

Now, note that your doctor will of course combine the information gained from the ACT or ACQ with a variety of other factors to determine the course of treatment for your asthma. They are to help guide the decision, but likely not useful to self-determine the next steps for your asthma care independently.

What do you think captures your level of asthma control better? How do you and your doctor determine whether or not your asthma is in control?