Loymans et al reported a score for identifying a patient with asthma who is at risk for severe exacerbations. The authors are from multiple institutions in Europe and participate in the U-BIOPRED study.
Patient selection: adult with asthma
There are 2 simple scores, one based on clinical history and one based on clinical history plus spirometry.
Parameters:
(1) Asthma Control Questionnaire (ACQ) of Juniper et al (ranges from 0 to 6)
(2) current smoking
(3) chronic sinusitis
(4) history of hospital admission for asthma
(5) history of steroid therapy in previous year?
(6) FEV1 by spirometry
|
Parameter
|
Finding
|
Clinical Score
|
Clinical Score Plus Spirometry
|
|
ACQ score
|
< 0.75
|
0
|
0
|
|
|
0.74 to 1.50
|
1
|
1
|
|
|
> 1.50
|
4
|
4
|
|
current smoker
|
no
|
0
|
0
|
|
|
yes
|
3
|
2.5
|
|
chronic sinusitis
|
no
|
0
|
0
|
|
|
yes
|
3
|
3.5
|
|
hospital admission
|
none
|
0
|
0
|
|
|
any
|
3
|
2.5
|
|
steroid therapy in past year
|
no
|
0
|
0
|
|
|
yes
|
5
|
5
|
|
FEV1 as percent of predicted
|
> 90%
|
NA
|
0
|
|
|
80 to 90%
|
NA
|
0.25
|
|
|
< 80%
|
NA
|
0.50
|
total scores =
= SUM(points for all of the parameters)
Interpretation:
• minimum score for both: 0
• maximums score for both: 18
• The higher the score the greater the risk of severe exacerbations.
X =
= (0.2879 * (score for clinical plus spirometry)) - 3.195
probability of severe exacerbations =
= 1 / (1+ EXP((-1) * X))
Performance:
• The area under the ROC curve for the external validation was 0.69.
