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Asthma Control Test (ACT)

Answer five questions about the past four weeks. Your ACT score (5–25) helps you and your doctor judge how well your asthma is controlled.

Reference period: the past 4 weeks. Pick exactly one answer per question.

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1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school, or home?

2. During the past 4 weeks, how often have you had shortness of breath?

3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness) wake you up at night or earlier than usual?

4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer (e.g. albuterol/salbutamol)?

5. How would you rate your asthma control during the past 4 weeks?

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Answer all 5 questions to see your ACT score.

Score interpretation

Well controlled

Maintain therapy and trigger avoidance

20 – 25
Not well controlled

Discuss therapy adjustment with your doctor

16 – 19
Poorly controlled

Seek medical review promptly

5 – 15

How it works

The Asthma Control Test (ACT) was validated by Nathan and colleagues in 2004 (J Allergy Clin Immunol). Five questions, scored 1–5 each, sum to 5–25 total. A score ≥ 20 indicates well-controlled asthma; ≤ 19 suggests treatment review. GINA recommends the ACT as a longitudinal monitoring tool.

The ACT is a screening and monitoring tool. It does not replace clinical diagnosis. For acute breathlessness, rescue inhaler use exceeding 4× per day, or rapid deterioration, seek medical attention immediately.

Frequently Asked Questions

What does the Asthma Control Test (ACT) measure?+
The ACT measures how well your asthma was controlled over the past 4 weeks. It captures activity limitation, shortness of breath, nighttime symptoms, rescue inhaler use, and your subjective control rating.
What do the score ranges mean?+
20–25 points: well controlled. 16–19 points: not well controlled. 5–15 points: poorly controlled. A score of 25 indicates complete control.
How often should I take the ACT?+
Every 3 months when stable; more often during therapy changes or worsening. Trends across multiple tests carry more weight than a single value.
What does a score below 20 mean?+
A score below 20 indicates your asthma was not optimally controlled in the past 4 weeks. That is a reason to discuss therapy adjustments or trigger avoidance with your doctor — not necessarily an emergency.
Is the ACT suitable for children?+
The ACT shown here is validated for adults and adolescents 12+ years. For children aged 4–11, use the Childhood Asthma Control Test (cACT) with age-appropriate items.
Does the ACT replace lung function testing?+
No. The ACT captures symptoms, not lung function. Spirometry (FEV1) or peak flow measurements complement the ACT — together they give the full picture of asthma control.
What if I have acute breathlessness despite a high ACT score?+
An acute attack overrides the ACT. Use your rescue inhaler (2–4 puffs of albuterol/salbutamol), sit upright, breathe calmly. If symptoms do not improve, call emergency services.

Background

Asthma Control Test (ACT) Guide: Score, Ranges, and Next Steps

8 min