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TENOR Risk Score for an Adult with Severe or Difficult-to-Treat Asthma

Purpose: To identify the risk of going to the ED or being hospitalized for an adult with severe or difficult-to-treat asthma.

Description

Miller et al developed a risk score based on the TENOR (The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens) study. This can help to identify a patient with severe or difficult-to-treat asthma who is at risk for an ED visit or hospitalization. The authors are from Genentech, Novartis, University of California, National Jewish Medical and Research Center (Denver) and Harvard Medical School.


Patient selection: adult (age 18+)

 

Parameters:

(1) age of the patient in years

(2) gender

(3) race

(4) body mass index (BMI) in kg per square meter

(5) lung function as percent of predicted FVC post bronchodilator

(6) previous history of pneumonia

(7) diabetes

(8) cataracts

(9) ever intubated

(10) number of steroid bursts in past 3 months

(11) ipratropium bromide nebulizer

(12) systemic corticosteroids

 

Parameter

Finding

Points

age of the patient

>= 60 years of age

0

 

50 to 59

1

 

35 to 49

2

 

18 to 34

3

gender

male

0

 

female

1

race

white

0

 

not-white

2

BMI

< 35 kg per square meter

0

 

>= 35 kg per square meter

1

lung function

>= 70% of predicted

0

 

< 70% of predicted

2

history of pneumonia

no

0

 

yes

1

diabetes

absent

0

 

present

1

cataracts

absent

0

 

present

1

ever intubated

no

0

 

yes

1

steroid bursts

none

0

 

1

1

 

2

2

 

3 or more

3

nebulizer with ipratropium

no

0

 

yes

1

systemic steroids

less often than every on other day

0

 

every other day or every day

1

 

total score =

= SUM(points for all 12 items)

 

Interpretation:

• minimum score: 0

• maximum score: 18

• The higher the score the greater the risk of an ED visit or hospitalization.

 

Total Score

Risk

ED or Hospital

0 to 4

low

2%

5 to 7

moderate

9%

8 to 18

high

26-29%

 


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Specialty

Objective

ICD-10