Aim and objectives: Since 2019 GINA Guidelines no longer recommend SABA-only regimen as PRN treatment for asthma worsening. Therefore, the explicit reference to SABA use as reliever in the fourth item of Asthma Control Test (ACT) might be misleading for patients, causing underestimate of ?as needed? treatment and, thus, overestimate of asthma control. Thus, our aim was to investigate whether there was any difference between routinely used ACT and GmACT.

Methods: 50 adult patients referred to our Asthma Center and diagnosed with asthma of any stage were enrolled in a pilot cross-sectional observational study. A panel of expert in respiratory medicine, together with a group of patients and caregivers, were asked to propose changes to item 4 according to current GINA guidelines. ACT and GmACT were administered in a randomized order.

Results: Sixteen over 50 patients (32%) answered discordantly to ACT and GmACT. Prevalence rose to 16/23 (70%) if we considered only patients reporting reliever therapy use in the last 4 weeks. Median score difference was of 3 points (GmACT always showing a lower total score compared to ACT, when discordant); this equals to the Minimal Clinically Important Difference for ACT in adults. Such median value was recorded in both well (n=5) and poorly controlled (n=11) patients (ACT>20 or <20, respectively).

Conclusion: A non-negligible amount of discordant results between GmACT and ACT was found in our cohort, with a clinically significant median score variation. Therefore, GmACT could potentially represent a more useful diagnostic tool for assessing asthma control. Given the small sample, further studies in larger populations will be needed to confirm our results.