October 2011, VOLUME128 /ISSUE Supplement 3

Status of Asthma Control in Pediatric Primary Care: Results From the Pediatric Asthma Control Characteristics and Prevalence Survey Study (ACCESS)

AH Liu, AW Gilesenan, R Stanford, W Lincourt, R Ziemiecki, H Ortega. J Pediatr. 2010;157(2):276281
  1. Sandy Jung-Wu, MD,
  2. Michael S. Kaplan, MD
  1. Los Angeles, CA


To determine the prevalence of uncontrolled asthma by using validated instruments in a representative sample of pediatric primary care offices.


Patients were recruited from pediatric outpatient offices across the United States. Eligible patients for this study included children who were between the ages of 4 and 17 years, had a history of asthma as diagnosed by a heath care provider, used an asthma medication in the previous year, and were able to read, write, and comprehend English.


This was a multisite cross-sectional study of patients with asthma who visited a pediatric health care provider for any reason between January and May 2008. The questionnaires given to the patients included the Childhood Asthma Control Test (C-ACT) for those between the ages of 4 and 11 years and the Asthma Control Test (ACT) for those between the ages of 12 and 17 years. Uncontrolled asthma was defined as a C-ACT or ACT score of <19. Each visit was also classified as either respiratory- or non–respiratory-related.


The overall prevalence of uncontrolled asthma was 46% (35% in patients with nonrespiratory complaints and 54% among those seen for a respiratory complaint). For patients evaluated for respiratory reasons, more children with uncontrolled asthma had missed ≥1 school day in the previous 4 weeks because of asthma (67% vs 29%; P < .0001). For patients seen for nonrespiratory reasons, more children with uncontrolled asthma had missed ≥1 day of school in the previous 4 weeks (53% vs 24%; P < .0001).


The number of missed school and work days resulting from uncontrolled asthma was not only greater for patients seen in a pediatric office for respiratory-related issues but also for non–respiratory-related reasons. This result highlights the burden and impact of uncontrolled asthma seen in all patients in pediatric clinics. Providers should consider evaluating asthma control on a regular basis regardless of the reason for the visit.


The ACT and C-ACT tools were designed to use only for children already diagnosed with asthma. The cutoff score of ≤19 is not an absolute indicator of uncontrolled asthma but should serve to alert the provider that asthma might not be well controlled. A report of using C-ACT scores to identify children with very poorly controlled asthma has been published previously (J Allergy Clin Immunol. 2010;126[2]:267–273).