High ACT score is not sufficient to reduce the risk of asthma exacerbations in asthma with low lung function

Abstract Background Low forced expiratory volume in 1 s (FEV 1 ) is a risk factor for asthma exacerbations (AEs). We aimed to determine if asthma control could reduce the future risk of AEs in patients with low FEV 1 . This study was conducted to evaluate the future risks of AEs within six months according to Asthma Control Test™ (ACT) score and FEV 1 . Methods A total of 565 patients with asthma were enrolled from the COREA cohort. The ACT score, lung function test, and number of AEs were assessed at baseline, three-month follow-up, and six-month follow-up with conventional asthma treatments by asthma specialists in real clinical settings. Results Female sex, low ACT score, low FEV 1 , low FVC, and AE history in the previous three months were related with increased AEs within six months. AEs during six-month follow-up occurred in 24% of patients with ACT 1 1 1 ≥ 2.16 L had experienced AEs (P = 0.01), although no differences were observed in the presence of AEs within six months according to the predicted FEV 1 (FEV 1  ≥ 60% vs. FEV 1 Conclusion Patient with low FEV 1 seemed to show higher risk of AEs than those with near-normal FEV 1 despite ACT score ≥20 and asthma treatments. Therefore, treatment strategies that prevent AEs are needed in high-risk asthmatic patients.