Abstract
Introduction
Asthma is a heterogeneous airway disease. Identifying predictors of severity and poor control is essential for improving outcomes. The asthma control test (ACT) and asthma control questionnaire (ACQ) are widely used, but their agreement with global initiative for asthma (GINA) classifications varies.
Objectives
To identify predictors of severe and uncontrolled asthma and compare ACT and ACQ performance with GINA-defined control.
Methods
In this cross-sectional study, 200 adult asthma patients were enrolled at Sohag University Hospital. Demographic, clinical and environmental data were collected with spirometry and blood eosinophil counts. Severity was classified by the GINA 2024 treatment steps. Asthma control was assessed using GINA, ACT and ACQ, with independent predictors identified through logistic regression.
Results
Mean age was 35.5 years; 72% were female. Severe asthma (7.9%) occurred mainly in older females with comorbidities, pollution exposure, eosinophilia and forced expiratory volume in one second (FEV1) < 60%. Reduced FEV1 was the strongest predictor (adjusted OR ≈22). Uncontrolled asthma (65%) was linked to SABA overuse, poor adherence, GERD, allergens and reduced FEV1. ACQ showed better agreement (κ = 0.61, AUC = 0.896) than ACT (κ = 0.54, AUC = 0.79).
Conclusion
Severe and uncontrolled asthma are strongly linked to impaired lung function and environmental exposures. ACQ aligns more closely with GINA and may outperform ACT in clinical use.