Asthma Center

Asthma Control Test Scores for Severe Asthma

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 are asked to complete the ACT when seen at initial and follow-up visits.

The 2021 data are 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 Poor asthma control is measured by the ACT and indicated by an ACT score < 20, and an increase of 3 has been shown to be the minimal important difference for the ACT.³

With the unprecedented events of the coronavirus pandemic, a larger scale evaluation was limited due to ACT availability during this time, as in-person visits were suspended and most management was remote via phone calls or virtual visits. However, data available were promising, demonstrating that asthma control in the most severe asthma patients improved.

Proportion of Severe Asthma Patients With Well Controlled Asthma Improved Between 2020 and 2021 (N = 228)

2020 – 2021

ACT = Asthma Control Test

The chart displays a cohort of 228 patients with severe asthma and ACT data available who were cared for in the Asthma Center. Analysis demonstrates that the proportion of patients with controlled asthma seen in 2020 and subsequently in 2021 improved during that time interval.

These outcomes data demonstrate that, with comprehensive evaluation and multidisciplinary management (and often multimodal management in-person/virtually/telephonically) of 228 patients with ACT scores presenting to the Asthma Center, improved asthma control is possible even in the most severe cases. Rigorous monitoring and adjustments of therapies are needed as patients improve or require alternative advanced therapies available.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.