Asthma Center

Asthma Control Test Scores During Visits in 2018

Asthma control can be formally assessed by using validated instruments, including the Asthma Control Test™ (ACT). The ACT includes 5 questions that assess daytime symptoms, nighttime symptoms, reliance on as-needed “rescue” medication, the effect of asthma on everyday functioning, and patient assessment of control, with each of these 5 responses scored on a 1 to 5 scale. Higher scores reflect improved asthma control, a major objective of asthma management.

The ACT has been routinely used at Cleveland Clinic’s Asthma Center for more than a decade. All asthma patients complete the ACT when seen at initial and follow-up visits.

The 2018 data are being reported in the context of a quality measure. The American Academy of Allergy, Asthma, and Immunology Qualified Clinical Data Registry (QCDR),¹⁻² which has been approved by Centers for Medicare and Medicaid Services, qualifies as a reporting tool for the Merit-based Incentive Payment System (MIPS).² The measure addresses the proportion of asthma patients whose asthma was either poorly or not well controlled, as indicated by an ACT score < 20 at baseline, who achieve an improvement of ≥ 3 at a subsequent visit during a 12-month period. An increase of 3 has been shown to be the minimal important difference for the ACT. ³

Improvement in ACT Scores for Patients With Poorly or Not Well Controlled Asthma at Initial Visit (N = 829)


ACT = Asthma Control Test

ᵃ A change in score of 3 represents the minimal important difference

ᵇ A score of 19 indicates good control

Of 1608 asthma patients who completed the ACT at initial and follow-up visits in 2018, 52% (N = 829) were poorly or not well controlled at initial visit. Of these patients, 56% (N = 461) demonstrated an improvement in ACT scores of ≥ 3 at follow-up. Furthermore 40% (N = 327) of patients achieved good control based on an ACT score > 19.

Cleveland Clinic’s Asthma Center uses various approaches and latest therapies to improve control for patients with asthma. These data offer evidence that care at the Asthma Center provides value and leads to improved asthma outcomes.⁴


  1. American Academy of Allergy, Asthma, and Immunology. The AAAAI QCDR., accessed April 19, 2019.

  2. Dinakar C, Lang DM. Quality measures in allergy, asthma, and immunology. Ann Allergy Asthma Immunol. 2015 Jun;114(6):435-439.

  3. Schatz M, Kosinski M, Yarlas AS, Hanlon J, Watson ME, Jhingran P. The minimally important difference of the Asthma Control Test. J Allergy Clin Immunol. 2009 Oct;124(4):719-723.

  4. Williams SA, Wagner S, Kannan H, Bolge SC. The association between asthma control and health care utilization, work productivity loss and health-related quality of life. J Occup Environ Med. 2009 Jul;51(7):780-785.