Instrument template · AsthmaUpdated September 28, 2026

Asthma Control Test eCRF template

Five questions about the last four weeks, each scored 1 to 5, for a total of 5 to 25. The ACT is one of the most used asthma control measures in trials and clinics. Build it as a phone questionnaire with the licence details recorded on the form.

  • 5 items, 5 to 25
  • Four-week recall
  • Licence tracked on the form

Free sandbox · No credit card · 21 CFR Part 11 aligned

Asthma Control Test · Subject 004-0019

Week 12 total

21 / 25

Well controlled
5-15 Very poorly controlled16-19 Not well controlled20-25 Well controlled
Baseline14
Week 417
Week 1221
Totals derived from coded item values

At a glance

  • Five items covering activity limitation, shortness of breath, night-time symptoms, rescue inhaler use and the person's own rating of control, all over the past four weeks.
  • Each item scores 1 to 5; the total runs from 5 to 25, with higher scores meaning better control.
  • A total of 19 or less is widely used to indicate asthma that is not well controlled; 20 to 25 suggests good control.
  • A change of about 3 points is commonly cited as clinically important.
  • The ACT is copyrighted. Check the terms of use and obtain permission before using it in a study.

In trials

How asthma trials use the ACT

The ACT gives a quick, patient-reported view of asthma control that complements lung function. Trials use it at screening to confirm uncontrolled asthma as an inclusion criterion, and at later visits as a secondary endpoint alongside FEV1, exacerbation rates and rescue medication use. Because it takes about a minute, it adds almost no burden to a visit.

The four-week recall period matters for scheduling. Administering the ACT every two weeks means each answer overlaps the last; most protocols collect it at visits four weeks or more apart. Record the date of completion precisely, because the endpoint is defined against that window.

Children

A separate Childhood Asthma Control Test (C-ACT) exists for children aged 4 to 11, with items answered by the child and others by the parent, and a different score range. Do not give the adult ACT to young children; use the version validated for the age group and record who answered each part. See the parent proxy ePRO template.

Asthma Control Test · Week 12

Past 4 weeks · approved licensed version

Item 1 · Activity limitation

ACT01
12345

Item 2 · Shortness of breath

ACT02
12345

Item 3 · Night-time symptoms

ACT03
12345
Licensed wording goes in your approved build

Structure

ACT items and scoring

ItemTopicScore
1Asthma limiting activities at work, school or home1 to 5
2Shortness of breath1 to 5
3Night-time waking or early waking from symptoms1 to 5
4Rescue inhaler or nebuliser use1 to 5
5Own rating of asthma control1 to 5
TotalSum of the five items5 to 25

Use the licensed wording and official translations supplied by the copyright holder. Item topics are summarised here, not reproduced.

In Capture

A one-minute questionnaire, scheduled to its recall period

Participants complete the ACT on their own phone from a secure link, with no app to install. Each item is stored as a coded value with its label, all five are required, and the form records the licence number, holder and expiry so collection stops if the licence lapses.

  • Visit-based schedule with windows and reminders.
  • Coded values and labels in every export.
  • Licence details on the form.
EDC for COPD and asthma trials
PROMIS SF v1.0 · Fatigue 8a · Settings

Copyright & licence

Approval pending
Licence required

Licence number

Not recorded

Expiry date

Not recorded

Watermark shown to staff only. Participants never see it.

Add the ACT to a sample asthma study

Build it with your licensed wording and preview it on your phone.

Use the ACT template free

Alongside the ACT

Control, lung function and exacerbations together

The ACT measures how asthma feels to the person; it does not replace objective measures. Most trials pair it with spirometry at visits, a daily diary of rescue inhaler use and symptoms, and an exacerbation form that records systemic corticosteroid courses, emergency visits and hospital admissions. The Asthma Control Questionnaire (ACQ) is an alternative control measure that includes a lung function item; pick one as the primary control measure rather than collecting both without a plan.

For analysis, define in advance whether you will use the total as a continuous outcome, the proportion reaching 20 or more, or the proportion improving by at least 3 points. Pre-specifying the definition in the analysis plan avoids choosing the most favourable one after unblinding.

Before go-live

ACT setup checklist

Permission obtained

Terms confirmed with the copyright holder; licence details on the form.

Right version for age

Adult ACT from 12 years; childhood version for ages 4 to 11.

Schedule matches recall

Visits four weeks or more apart.

All items required

A total needs all five answers.

Endpoint defined

Continuous total, threshold of 20 or change of 3 points.

Official translations

For every language used in the study.

FAQ

Questions about this template

Something not covered here? Ask us directly.

How is the Asthma Control Test scored?

Five items are each scored 1 to 5 and summed for a total of 5 to 25. Higher scores mean better control.

What ACT score means uncontrolled asthma?

A total of 19 or less is widely used to indicate asthma that is not well controlled.

What change in ACT is clinically important?

About 3 points is commonly cited. Pre-specify the threshold in your analysis plan.

Is the ACT free to use?

It is copyrighted. Check the terms of use with the copyright holder and obtain permission before using it in a study.

Can children complete the ACT?

Children aged 4 to 11 use the Childhood Asthma Control Test, which has a different structure and score range.

Does Capture calculate the ACT total?

Items are stored as coded values with labels, and totals are derived from them in analysis.

Asthma control on participants' phones

Licensed instruments with licence tracking. Free sandbox.

Use the ACT template free